Bite Back with Abbey Sharp - Is Sugar Making You Sick and Fat? The Bitter Truth about Sugar, Diabetes, Weight Gain and Inflammation

Starting point is 00:00:00 There is this ever-growing body of content online from healthy content creators without diabetes who are tracking their blood sugars religiously and then freaking the fuck out when they see any kind of uptick after a meal. And I'm not talking about an uptick after a pizza mukbang. I'm talking about influencers who are getting anxious watching their blood sugar graph after they eat a fucking peach, guys. Hi everyone, and welcome to another episode of Bite Back with Abbey Sharp, where I dismantle diet culture rules, call out the charlatans spinning the pseudoscience, and help you achieve food freedom for good. And speaking of diet culture, today we're talking about the apparent public enemy number one,

Starting point is 00:00:51 sugar. It's been called toxic, a silent killer, a straight-up poison, and it has been consistently, if not exclusively, blamed for virtually anything under the sun. From obesity to diabetes to mental illness and more. Today, we're talking about sugar. This comes at a time of year when you're likely not only surrounded by the stuff, but also bombarded with a lot of over-the-top fear-mongering messages about it too. So my goal for today's solo episode of Bite Back is to empower you with the facts, tips, and tools so that you can enter this sweet season with a greater sense of confidence

Starting point is 00:01:39 and calm. A big thank you to my colleague and friend, Dr. Eric Williamson for consulting on this script. Eric is a fellow registered dietitian with a PhD who specializes in weight loss, sports nutrition, and longevity. He's absolutely the best of the best. So I'm going to be leaving some links to his amazing content below if you're looking for more evidence-based nutrition content. Also a quick reminder to please make sure to follow Bite Back so that you never miss an episode and to leave us a little review because as a new podcast, it really does help us out. All right, if you have ever googled the words sugar and bad, you've probably been fed a million listicles and blogs about how sugar and sugar alone is making you fat, sad, and sick. And let's

Starting point is 00:02:39 not get confused here. These claims are grounded in some evidence. But in a lot of cases, that evidence has been oversimplified and sensationalized to the point of having no real meaning at all. Basically what we see going on with every other nutrition fact we read online. But let's take this in baby bites and tackle one not-so-sweet claim at a time. Starting with claim number one, sugar causes a dangerous spike in blood sugar and insulin. Between those science-y looking blood sugar graphs and charts that you might see on your feed and fit girlies rocking glucose monitors on their arm as if it's like part of their fashion look, the last few years have seen an overwhelming amount of buzz about blood sugars and insulin. Now if you have diabetes or insulin

Starting point is 00:03:35 resistance, then you've hopefully received some education around what these concepts mean. But I feel like now we're seeing completely healthy fit women online wax poetic about their blood sugar numbers and insulin levels without fully grasping what they actually even mean. So here's a super duper quick blood sugars 101. In healthy individuals without insulin resistance or diabetes, our body runs a very tight ship to maintain blood sugar homeostasis. When we eat carbohydrate-containing foods, the carbs get broken down into simple sugars and that sugar shows up in our blood. In response, our pancreas releases a hormone called insulin. Now insulin is like the key that opens the lock

Starting point is 00:04:27 on our cells to let the sugar in. So for example, our muscle cells get unlocked by insulin, the sugar rushes into our muscles, and that sugar is used as energy to move. Now at that point, our blood sugar levels will then come down, our insulin levels will decline, and we eventually will get the signal that it's time to eat. If we ignore that cue and our blood sugars get too low for comfort, our body then releases a different hormone called glucagon, which converts the stored glycogen into glucose, which can then enter the blood. The liver can also help manufacture sugar that our muscles can use by a process called gluconeogenesis. Now, in a healthy individual

Starting point is 00:05:12 without insulin resistance or diabetes, we really do not have to think about our blood sugars getting dangerously too high or too low. Because again, we've got this set of hormones to maintain homeostasis with military precision. In fact, research in healthy populations suggests that 96% of the time our blood sugar levels might show an immediate transient spike after eating something very high in carbs, but they will return back to normal range within one to two hours. Yes, even if you do eat your way through the selection of mini desserts at the holiday party. And we do have some evidence to back this up. So for example, in a famous 2020 study, affectionately known as the all-you-can-eat pizza study, they threw a big pizza party for a bunch of healthy men. In one study

Starting point is 00:06:07 protocol, they were told to eat as much pizza as they wanted to stay comfortably full, and then in another, they were told to eat as much as they possibly could without like literally popping a seam. The first finding was that these healthy men could eat about twice as much as what made them feel comfortably full, so there's that. But what was more interesting was what happened to their blood sugar and insulin levels after all those carbs. Basically insulin understood the assignment. The pancreas pumped insulin out in a linear fashion for the entire duration of their all-you-can-eat feast. The more pizza they ate, the more insulin their pancreas released.

Starting point is 00:06:51 And because insulin is just like such a badass hormone superstar, their blood sugar levels peaked at a certain point and then basically leveled off. So there was actually no difference in the blood sugar peak when they ate 187 grams of carbs versus when they ate 367 grams. So the takeaway here is that even in a healthy individual, like even if you were to eat the party size pizza yourself, your pancreas would step up to the plate, like almost literally, and get you back in line before any damage to your metabolic health could be done. Now, to be clear, I am not suggesting anybody does that. But the reason why I bring up this extreme example is because there is this ever-growing body of content online from healthy content creators without diabetes

Starting point is 00:07:47 who are tracking their blood sugars religiously and then freaking the fuck out when they see any kind of uptick after a meal. And I'm not talking about an uptick after a pizza mukbang. I'm talking about influencers who are getting anxious watching their blood sugar graph after they eat a peach. A fucking peach, guys. Like, this obsession and fear of any increase in blood sugars and insulin has really led to a lot of folks becoming unnecessarily weary of any and all carb-containing foods, including super nutritious ones like fruits, whole grains, legumes, and dairy. What I want people to know is that it is completely normal and healthy for blood sugars to go up and down between and during your meals. And in a person

Starting point is 00:08:43 without insulin resistance, our body is damn good at keeping our levels within the normal healthy range by pumping out the right cocktail of hormones. So if you do overindulge at the holiday party on like the puff pastry pinwheels, you're not putting your body in imminent danger and you're absolutely not doing harm by eating a peach. But now you might be thinking, well, then, Abby, does that mean I can just, like, go on a week-long candy cane bender with no recourse because I don't currently have diabetes? Well, this is going to be a really good segue to addressing some of the other most popular assumptions about sugar, namely around it being the direct cause of diabetes and obesity. But the answer to that question is no. Even if a transient bump in blood sugars isn't dangerous in that moment,

Starting point is 00:09:38 we don't want to abuse our healthy pancreas privileges by only eating high sugar foods. And here's why. To start, experiencing that imminent, albeit transient, uptick in blood sugar after like a double portion of pie generally just doesn't feel very good. So you might feel a little shaky or thirsty or sweaty or even anxious. Then as your pancreas pours in a motherload of insulin and your blood sugars drop, you might get a new set of unpleasant symptoms. So you might be feeling irritable, fatigued, weak, and hangry. If you have ever been woken up feeling ravenous in the middle of the night right after a big festive meal, it's probably a little short bout of hypoglycemia as your hormones scramble to kind of figure their shit out. And what do we normally

Starting point is 00:10:32 do when we're feeling ravenous in the middle of the night? We tiptoe down to the fridge for leftover pie to bring our blood sugars back up. So I want you guys to like keep that in the back of your mind as I address the next two common sugar concerns. So claim number two is that sugar is solely responsible for the obesity epidemic. First of all, I need to put it out there that between 40 to 70% of obesity risk is hereditary. But if we were to just like put genetics aside for a hot minute, we do know that there's a lot of data linking sugar consumption to weight gain. And while diet culture loves to oversimplify to claim that sugar inherently and automatically makes you fat, there are a lot of ifs, ands,

Starting point is 00:11:32 and buts here that we need to unpack. So first of all, if we're talking straight up refined sugar, or what I like to call naked carbs, we know that because they generally lack fiber, protein, and healthy fats, aka my hunger crushing compounds, they are digested and absorbed pretty quickly. The result is that sugar just doesn't keep you full for very long. So if we eat a bowl of high sugar Lucky Charms for breakfast with no protein, fat, or fiber to be found, we're likely going to be looking for breakfast number two in the communal donut box, for example, when we get to work. Likewise, as I mentioned a moment ago, if we eat a lot of sugary naked carbs and end

Starting point is 00:12:21 up with a more aggressive spike in blood sugar, the rebound blood sugar low can make us feel ravenous and hungry. So even if you've technically consumed enough calories in your cereal breakfast, you might be reaching for another meal to get your blood sugars back up, which again just adds more calories to your day. Finally, while fully unpacking the idea of sugar addiction likely requires a whole other podcast episode, I will say that sugar does increase our feel-good hormones like dopamine and serotonin, so they're just generally more pleasurable to eat

Starting point is 00:13:00 and therefore easier to overeat. In all of these situations, there's basically just an increased risk that one naked carb snack or meal will get chased by another to fill a physical or emotional void, typically leading to a calorie surplus, which ultimately results in gained fat. An increased risk doesn't mean that sugar will inevitably make you fat. It's simply that for most people, sugar is easier to overeat than like chicken or kale. So this is the relatively simple part of this. But the anti-carb charlatans love to complicate this by going off about how insulin is a big bad fat storage hormone. All right, the story generally goes

Starting point is 00:13:46 that if you eat any amount of carbs from any source, including really healthy foods like fruit or grains, your body will need to produce insulin. And when any amount of insulin is released, our body seemingly like flips the switch from fat burning to fat storage mode. And I understand why keto dieters push this idea because it's true. Like once you use up the glucose in your blood for immediate needs and there's still some left over, insulin will help to store it as glycogen. And

Starting point is 00:14:19 then after that in our fat cells for, you know, a rainy day. But very simply, this still just comes down to calories. If we're not eating more calories than our body needs, and we have a healthy working pancreas, aka we don't have diabetes, there is no reason for insulin to store glucose as fat. So the bottom line is this, sugar is not inherently fattening, nor is it the direct cause of obesity. If it was, we wouldn't see evidence that the sugars in whole foods like fruit and dairy, which are bound up with protein, fat, or fiber, are actually associated with a reduction in weight gain. We also wouldn't see virtually no difference in weight loss outcomes when people eat low carb versus low fat, and we wouldn't see comparable

Starting point is 00:15:12 associations with weight gain when we look at other non-sugary foods like processed meats and fried foods, or even inactivity. Sugar is just kind of easy to overeat. So we want to be mindful of combining it with hunger crushing compounds and consuming it within the context of our daily calorie needs. But it's this context that influences weight gain far more than the sugar itself. And this leads us to the next related claim that sugar causes diabetes. Now the relationship between sugar and diabetes is actually intimately entangled in the relationship between sugar and obesity because basically these three things affect one another. And where they intersect is in a concept called insulin sensitivity. So insulin sensitivity refers to how responsive your cells are to the hormone insulin.

Starting point is 00:16:15 If you want to think back to the lock and key analogy, folks with high insulin sensitivity have like a perfectly fitting key that slides right into the lock. Whereas folks with low insulin sensitivity, also known as insulin resistance, see that the locks on the cells are like rusty or damaged or stuck. So even though insulin may be present, it just doesn't work as well because it just can't open the cell. So insulin resistance is like the early stages of type 2 diabetes, and it can be influenced by a wide range of variables including physical inactivity, age, hormonal dysfunction like PCOS, sleep disturbances, chronic stress, certain medications, non-alcoholic fatty liver disease,

Starting point is 00:17:07 and genetics. In fact, type 2 diabetes is on average about 50% hereditary. So one person could eat like only sugars and not develop diabetes, while someone else may eat a high protein keto diet and be predisposed. But genetics aside for a second, there is absolutely a strong association between sugar consumption and type 2 diabetes. But if sugar does affect diabetes risks, it's largely through its role in increasing the risk of fat gain, specifically that internal visceral fat. So here are the basic steps on how this comes to be. So it generally starts with gaining weight. When we eat more calories than our body needs, and it's not being used to build muscle, we end up gaining fat. And as we have established,

Starting point is 00:18:01 sugar is easy to overeat because it's super pleasurable and delicious, but not very satiating. Eventually, we start to gain visceral fat around our liver and around our midsection, which kind of acts like a thick layer of sound dampening insulation. Now that insulation prevents the pancreas and the liver from being able to receive signals about how much sugar is actually in the blood, which throws off the sensitivity of our insulin dials that we just discussed. So now, even though there is already adequate sugar in the blood, the liver thinks we're running low because it hasn't gotten the communication. So it starts to dump glucose into

Starting point is 00:18:45 the blood as well. It's kind of like a malfunctioning thermostat that keeps pumping out heat even though the house has been a sauna for hours. The other thing that may be happening is back to that idea of insulin as a big bad fat storing hormone. In someone with high insulin sensitivity, the body can detect and utilize small amounts of insulin for the job. But with insulin resistance, insulin levels can become chronically high, preventing fat breakdown and encouraging fat storage. So at this point, we are gaining body fat, including that visceral fat, our blood sugar is going up, and our insulin is

Starting point is 00:19:27 also creeping up. Then in stage two, we see that that visceral fat can further worsen the insulin resistance. Contrary to what diet culture might have you believe, body fat is not just a storage site for excess energy that society doesn't like the look of. It's actually an endocrine organ that secretes inflammatory substances called cytokines, which then can interfere with normal blood sugar management communication. So now, even if we just ate, the insulin is not able to get the glucose into the cells. So our cells are screaming like, I am starving, can somebody feed me? And the result is that our blood sugars will continue to rise, the insulin isn't able to get the energy into our cells, and because we are really, really hangry,

Starting point is 00:20:16 we continue to eat and continue to gain weight. Finally, as an excess of fat builds up in the liver and in the pancreas, it interferes with the beta cells responsible for producing insulin. If our beta cells are impaired, our cells across the body, like our muscle cells, can't be receiving any of the keys, aka insulin, to get the energy from the sugar we eat into our hungry cells. So now our blood sugar is very high, our insulin levels are suppressed because our beta cells are malfunctioning, and we are still hungry AF.

Starting point is 00:20:54 Now, the role of visceral fat in type 2 diabetes is also coupled with physical inactivity. Not only does exercise help prevent and reduce visceral fat, which could counter the excess calories from sugar or really anything else, for example, but exercise also helps to disrupt the inflammatory cytokine cycle that impairs insulin and blood sugar communication. So to sum this up, no, sugar itself does not directly cause diabetes. In fact, if you were to gain a lot of visceral fat by eating like a low carb keto diet of bunless bacon cheeseburgers while sitting on the couch all day, you could still also develop type 2 diabetes.

Starting point is 00:21:41 So when we look at all studies where calories are actually controlled and there's no change in body composition, we don't actually see the link between sugar intake and diabetes risk. And I know this is a mindfuck because when we think of diabetes, we have been trained to automatically think carbs. But the reality is we should actually simply be thinking about calorie balance. We also should simply be thinking about ways to improve our insulin sensitivity. And the best evidence-based ways to do that include maintaining a healthy body composition, specifically by increasing muscle mass and reducing visceral belly fat, engaging in daily physical activity, having a solid sleep and stress management regimen to reduce chronic cortisol, and dressing up naked carbs with hunger

Starting point is 00:22:35 crushing compounds. None of these things require that you need to go low or no carb. So we can absolutely still enjoy sugar within our daily calorie needs and not have it cause metabolic harm. So we've covered two of the major chronic diseases that sugar is most often blamed for, which is diabetes and obesity. But sugar is really the scapegoat for literally anything and everything that ails you because it is thought to be quote-unquote pro-inflammatory. So I want to round this episode off by addressing the claim that sugar causes inflammation and by association chronic disease. Claim four, sugar causes inflammation and chronic disease so it is true that excess sugar is

Starting point is 00:23:32 associated with a wide range of chronic diseases from cancer to liver disease to dementia to early mortality but is this because sugars are inherently toxic or because of their inflammatory properties? Or is it actually something else? Well, first of all, despite inflammation being a top five wellness influencer buzzword, it's actually probably not what you think. Inflammation is not about like looking puffy or bloated after you eat ice cream. Inflammation is actually just your body's response to any potential intruder. And acute inflammation is really not a concern, because that is totally normal, and it's a natural process, and it's a very important bodily process. In fact, your body

Starting point is 00:24:19 is technically in a state of inflammation after you work out, and no one out here is claiming that Pilates is causing cancer. But it's the chronic inflammation that can increase the risk of chronic disease. So here's the irony. When we look at research in individuals with healthy weights, aka who do not carry an excess of fat around their midsection, which may increase the risk of insulin resistance, there is no direct impact of sugar on inflammation. And to give you an extreme example of this, we can consider athletes. So research looking at the diets of cyclists on the Tour de France were found to be consuming nearly 500 grams of simple carbs, aka sugar, per day. Other research has shown that a lot of elite runners are generally consuming

Starting point is 00:25:13 well over 100 grams of simple sugars every single day for years, even when they're not actually doing a race that day. If sugar was truly inflammatory and disease-causing, these athletes would all be dying like middle age. But in fact, endurance athletes have the lowest levels of inflammation, lowest risk of diseases like diabetes, and some of the longest life expectancies compared to other populations. So no, sugar itself is not directly causing inflammation or chronic disease. What is at play here is what we call the mediating factors, which as we've discussed throughout this episode, are largely believed to be the combination of excess visceral fat and inactivity. To wrap up this very long-winded way of telling you that it's not the end of the world if you eat a Ferrero Rocher tonight, is that sugar consumption,

Starting point is 00:26:13 obesity, and chronic diseases, including type 2 diabetes, are in a bit of a fruple love triangle. Sugar itself doesn't directly cause diabetes or other diseases, and it also doesn't directly cause obesity. But because it is easy to overeat, it is a potential road to a calorie surplus, which then leads to excess visceral fat gain, which then increases the risk of insulin resistance, type 2 diabetes, and other inflammatory diseases. The truth is that sugar is never going to be a superfood. But just because it's kind of a dud in the nutrition department doesn't mean we should liken it to like cyanide.

Starting point is 00:26:58 This mentality and the extreme restriction that often comes from it can easily become a really slippery slope for disordered eating and orthorexic tendencies. Sugar ultimately brings us joy. It's part of so many important memories that we have and it can absolutely fit into a healthy balanced diet without causing harm. The key is to consider the context in which it's consumed. How much, what are we eating with it, and how is it affecting our overall energy balance and weight? So here are some evidence-based recommendations to help you feel more at ease about sugar this season and beyond. First of all, consider the amount. How much sugar you can eat without recourse will ultimately depend on your existing metabolic state and calorie needs.

Starting point is 00:27:48 But if we look at the current population guidelines, we see the suggestion to limit added sugars to 5 to 10% of your total calories. And I'm talking added sugars here, so not the sugars that are found in whole foods like fruit or dairy, which come bound up with those satiating hunger crushing compounds. So for a 2000 calorie diet, that would be less than a 16 ounce bottle of Coke, a slice of birthday cake, or a cup of ice cream. Now keep in mind that this is the maximum amount that experts believe may still allow the average person to meet their other base nutrient needs while not exceeding their total calorie needs. And it also has to include all of the little sources of added sugar in our day from things like sauces, dips, dressing, cereal, bread, etc. So most people won't be having a cup of ice cream every single day, especially folks

Starting point is 00:28:47 who are looking to lose weight, where the full 10% might end up edging out too many satiating foods that would make staying in that calorie deficit easier. That said, this still leaves a good amount of room for plenty of treats around the holiday season, especially when combined with other nutritious foods. Which brings me to our next context consideration. What are we eating the sugar with? This is where my trademarked framework, the hunger crushing combo, comes in. That is, we ideally want to dress up those naked carbs, aka sugar, with the hunger-crushing compounds fiber, protein, and healthy fats. So if we are pairing that slice of cake with some Greek yogurt, berries, and nuts, a few

Starting point is 00:29:37 important things may be happening to reduce the risk that that added sugar may negatively affect our health. For one, the dessert is now way more satiating, which might end up reducing the portion of the size of the cake that we need to feel satisfied. Two, because the hunger crushing compounds do slow down digestion and do make us feel fuller for longer, it may help prevent a follow-up high sugar snack.

Starting point is 00:30:03 And three, those hunger crushing compounds also help to buffer the blood sugar response. So we're just less likely to get that rebound crash that makes us ravenous and looking for another snack. Taken together, simply combining sugar with hunger crushing compounds reduces the risk of overeating, which reduces the risk of excess

Starting point is 00:30:25 fat gain, insulin resistance, or other chronic diseases. And finally, number three, how does that sugar affect our overall calorie balance? If you're following the first two recommendations, this typically will fall into place. But of course, exercise can also play a role in this, not only by contributing to energy expenditure, which would increase how much sugar or really anything else that you could eat without gaining visceral fat, but also by improving insulin sensitivity. As we've discussed, excess visceral body fat and inactivity are far better predictors of insulin resistance than sugar itself. So if we are engaging in daily physical activity and maintaining a nutrient-dense, energy-balanced diet, there is little to no risk of a little sugar doing any harm.

Starting point is 00:31:23 The goal for this episode was certainly not to suggest that you should be eating, you know, sugar cookies three meals a day from Thanksgiving to New Year. And it also certainly wasn't to insinuate that obesity, diabetes, or really any other chronic disease is solely an individual's fault. As I've mentioned earlier, these conditions are wildly hereditary and also are influenced by a multitude of systemic factors that really go beyond the scope of this episode today. I simply want to make you feel a little bit more at ease about the sweet season ahead, knowing that a single uptick in blood sugars from like a carb heavy meal is not going to be your demise. Maybe you'll also now be armed with some facts about blood sugar homeostasis for whenever

Starting point is 00:32:11 your diet Debbie ant inevitably stares down your stuffing and potatoes that you have on your plate. You go ahead and tell her that insulin understands the assignment and you're going to be all right. Also, the next time you see an influencer simply call sugar toxic or a poison without going through like 30 minutes of facts that I just unpacked, you'll hopefully know what to do. Delete, block, and scroll. Before I sign off, I would love, love, love if you would leave me a review and share this episode with friends and family who are perhaps becoming increasingly fearful or dogmatic about sugar. I would love you to help me bite back

Starting point is 00:32:50 against the food fear-mongering and sensationalism that social media promotes. But signing off with Science and Sass, I'm Abbey Sharp. Thanks for listening. Thank you.

Bite Back with Abbey Sharp - Is Sugar Making You Sick and Fat? The Bitter Truth about Sugar, Diabetes, Weight Gain and Inflammation

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