The Dr. Hyman Show - Are Some Sugars And Sweeteners Better Than Others?

Episode Date: February 28, 2022

This episode is brought to you by Eight Sleep and Athletic Greens.   Sugar is the number-one thing we can all use less of in our lives—in fact, just thinking about it releases insulin! Sugar turns on many mechanisms of disease and death, including inflammation. It fuels cancer and heart disease, it drives hormonal changes, it slows metabolism, and it literally shuts down the body’s ability to burn fat. On top of all that, sugar is highly addictive: the more we eat, the more we want.  In this episode of my Masterclass series, I am interviewed by my good friend and podcast host Dhru Purohit about why sugar is so harmful to our health, why the type of sugar really doesn’t matter, and much more.  Dhru Purohit is a podcast host, serial entrepreneur, and investor in the health and wellness industry. His podcast, The Dhru Purohit Podcast, is a top-50 global health podcast with over 30 million unique downloads. His interviews focus on the inner workings of the brain and the body and feature the brightest minds in wellness, medicine, and mindset. This episode is brought to you by Eight Sleep and Athletic Greens.   Eight Sleep’s Pod Pro mattress is so smart that it adjusts your temperature and also gives you individualized recommendations on how to sleep better the next night. To get yours, go to eightsleep.com/mark to check out the Pod Pro mattress or mattress cover and save $150 at checkout.   AG1 contains 75 high-quality vitamins, minerals, whole-food sourced superfoods, probiotics, and adaptogens to support your entire body. Right now, when you purchase AG1 from Athletic Greens, you will receive 10 FREE travel packs with your first purchase by visiting athleticgreens.com/hyman.   In this episode, we discuss (audio version / Apple Subscriber version):   Why sugar is so detrimental to your health (4:39 / 1:04)  Sugar dosage and how it compounds throughout the day (11:45 / 8:20)  Are healthier sugar options really any better? (15:53 /11:23)  The many different types of sugar (19:43 / 16:02)  What to look for to see how your body responds to sugar, including labs (28:21 / 24:35) Questions from our community, including the impact of sugar on the microbiome, fungal overgrowth, natural food-based sugars, and more (37:20 / 33:46) 

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to take ownership over your health and pick up the ultimate daily nutritional insurance. Now let's get back to this week's episode of The Doctor's Pharmacy. Hey everybody, it's Dr. Mark Hyman. Welcome to a new series on The Doctor's Pharmacy called Masterclass, where we dive deep into popular health topics, including inflammation, autoimmune disease, brain health, sleep, and so much more. Today I'm joined by my guest host, my good friend, my business partner, and host of the Drew Prod podcast, Drew Prod himself. And we're going to be talking about my favorite subject, which is sugar and all things sugar and why we should care and why you need to focus on sugar and flour in your life as the root of so many evils that are

disturbing your health and equilibrium. And I'm so excited to dive into this topic because I've written about 18 books on it. And so welcome, Drew. Mark, it's great to be here. Sugar is always a topic that people have so many questions about. And sometimes the titles of these podcasts can seem a little bit alarming, but really the fact is that sugar is actually a major contributor to chronic disease and people dying early. Help us understand, put it in context or any stats that you might have to really help people understand that actually sugar is playing a major role in people dying early and being sicker in their life. Absolutely. I mean, you know, we all were trained and I was trained because I'm old now, I was trained in the era when it was fat that was a boogeyman. Fat was going to make you fat. Fat was going to cause heart

disease and strokes. Fat was going to make you sick and fat. The truth is that it's not fat, it's sugar. And that I've written about a lot in the blood sugar solution, in the 10-day detox diet, in food, what the heck should I eat, in the vegan diet. I mean, there's plenty out there about this sugar issue from my perspective. And the biology of sugar is fascinating because historically, we only consumed about 22 teaspoons a year if we were lucky and found maybe some honey or we had a lot of berries, We get a little rush of sugar. Or maybe we're like the Nepalese honey hunters, where they had to literally climb a tree 100 feet high with a smoking bush to get the honey out of the tree. Imagine if you had to climb a tree with a smoking

bush 100 feet to get a cookie, right? But now we are living in a sea of sugar and flour. The average American eats about 152 pounds of sugar per year, per person, 133 pounds of flour per year, per person. And we'll get into why flour may be worse than sugar. I'm talking about wheat flour, whole wheat flour, regular flour, any kind of flour, and why that is causing havoc in our biology. So you ask the question,

what does it do when we consume this with sugar? Well, if we're consuming a berry here, a little bit of honey there, not a problem. Our bodies are designed for starvation. So whenever we got to see a lot of calories or a lot of starch or a lot of sugar, the body knew exactly what to do to get through the winter. It would store those calories in your belly and it would put on a lot of belly fat. And this is what bears do. I mean, I was in Alaska. I remember with my daughter kayaking a few years ago, and we went to Adventity Island, which has the highest concentration of grizzly bears. And they were fishing for salmon. You could go to this one little spot. You could stand there. You're used to humans. And they were fishing for

salmon. And they would eat the salmon all day long. And they wouldn't really gain that much weight. And then in the summer, they'd go up in the mountains, and they would eat the berries. And they eat literally hundreds of pounds of of berries and they would gain 500 pounds. Then they would go to sleep all winter. And basically, they would become diabetic and hypertensive and overweight, but then they would just live off that all winter. The problem is we just keep eating all winter. We don't have winter. We basically just eat all winter. And so we're consuming massive amounts of calories in the form of starch and sugar that are driving this ancient pathway to store belly fat. Now, why is belly fat bad? Well, it turns out that belly fat is the fat around your organs. It's the visceral fat. It's the fat that coats your

liver, your kidneys, your intestines, all this fat. It's not the subcutaneous fat or the fat on your butt or your thighs. It's the belly fat. And that fat is so active. It's not just there holding up your pants. It produces all kinds of molecules. One of them we've heard about, which are called cytokines. You might've heard of the cytokine storm. Why is about 80% of the deaths caused or occur of COVID in people who are overweight or obese? Because they are literally a firestorm waiting to happen. Their fat cells make cytokines, particularly one called interleukin-6. And this is fuel for the fire, not just for COVID, but for all chronic disease, high blood pressure, heart disease,

cancer, dementia, kidney disease. All these chronic illnesses are the result of this belly fat, of this visceral fat, which is producing hormones, neurotransmitters, inflammatory molecules. And it literally, when you get the fat in those cells, in your belly fat cells, because of the way the body works with high insulin levels, the insulin lets the sugar and the fuel into the fat cells, but it doesn't let it out. So it's like a one-way turnstile on the subway. All the calories get in, but they don't get out. So basically, you shut down what we call a lipolysis, which is fat burning. So by eating sugar, you literally shut down your ability to burn the fat off your body. Second, and I don't just mean the fat you eat, the fat off your body. The second is it slows your metabolism. Third, it actually creates inflammation. Fourth, it drives

horrible hormonal changes in men and women that make basically men into women and women into men. You get men with men boobs and you get women with facial hair and hair loss on their head because of the changes in the hormones that happen from the visceral fat. And then you get shrinkage of your brain and the hippocampus goes down. So the memory center goes down. That's why we're calling Alzheimer's type three diabetes. And if that weren't bad enough, it also fuels cancer cells. Cancer loves sugar. So basically, you're fueling every disease that is resulting from sugar that causes chronic disease, heart disease, cancer, diabetes, Alzheimer's, all the things that we see as we age, high blood pressure, kidney disease, and more. And so, and when we sort of take a step back and we look at, wow, why are we seeing in America major advances

in science and the most money by a factor of two or three or four that other countries spend on healthcare? And we're seeing worse and worse and worse results. I mean, the US has the worst COVID outcomes. Why? Because we're the sixth population. Why? Because we eat too much sugar and flour. And so people really need to understand that this is something that is within their grasp to fix and that sugar is not only harmful in the sense of the volumes of sugar we're eating and the consequences, but it's also highly addictive. And we'll get into talking about that. So in short, when you eat starch and sugar, it turns on all the mechanisms of your body for disease and death. In short, it's going to kill you.

In short, it's simple. But I would say, Drew, I would say that Paracelsus, who's one of the fathers of Greek medicine, ancient medicine, he said, the dose makes the poison. So is having one scoop of ice cream occasionally going to kill you? No. Is having a little bit of chocolate going to kill you? No. I'm talking about the pounds and pounds of added sugar to our diet. Every single thing in our diet has sugar in it. Your Prego tomato sauce has more per serving of sugar than two Oreo cookies. You know, drinking a, you know, having your orange juice, which is supposed to be healthy, is like basically drinking a can of soda. So we really need to take a step back and look at all the added sugar to our diet. It's not the

sugar we added when we're cooking something. It's the sugar that's added by corporations to our diet that causes the problem. And I think that's a great place to start because so many people feel like, but Dr. Hyman, I'm not eating a bunch of candy. I don't have Twix in my house. I don't have Snickers. I don't have all this stuff that you would take. I don't eat a lot of baked goods. So break down a few other things. And let's start with breakfast and give us some examples. You mentioned orange juice, for example.

And that's even a more challenging form of sugar because it's a liquid form, right? Now, in the context of this, again, the dose makes the poison. So we're talking about people doing this day in and day out, year over year for 10 years, 20 years, 30 years, 40 years. And that's how we end up in this chronic disease epidemic. So walk us through the day, help people understand that even if they're not eating a lot of candy and baked goods, they're still getting these pharmacological doses of sugar as they continue to eat. Yeah, these are pharmacologic doses. sugar as they continue to eat. Yeah, these are pharmacologic

doses. That is exactly right, Drew. These are pharmacologic doses, massive doses that our biology has never been used to eating. And we think, oh, we're not getting that much sugar. But I was in the movie Fed Up, and there was a great graphic where they showed what you had for breakfast, lunch, and dinner, and how all had added sugar. So for breakfast, cereal, right? We're eating cereal for breakfast. Oh, cereal is healthy. Even the healthiest cereal is pretty much polarized flour, which is just like sugar. So Honey Nut Cheerios, which sounds like a healthy honey nut Cheerios, sounds healthy, is probably one of the worst in terms of its glycemic index in terms of raising your blood sugar based on data that is coming out of Levels and Casey Means' work with her company

looking at continuous glucose monitoring. So cereal is basically 75% sugar, and it shouldn't be called breakfast. It should be called dessert. Not only that, what else do people eat for breakfast? They have their frappa chapa lappa lappa lattes with a million calories of sugar in there. I think the average large grande or whatever the vente has probably two times the amount of sugar as you see in a Coca-Cola, for example, and we're having that for breakfast, or we're having a muffin or a bagel, we're having French toast or pancakes or bread or toast. Those are all highly absorbable forms of starch or sugar that are just terrible for you. And then for lunch, we might have a sandwich, we might have a glass of juice, we might have potato chips, We might have a glass of juice. We might have potato chips.

We might have salad. But of course, we're going to have salad dressing on it. But most of the salad dressing is full of sugar if you look at prepared salad dressings. So you're getting flour and chips and potatoes. You're getting all these forms of starch and sugar that are doing the same thing. And dinner, the same thing. You know, we'll often eat potatoes and rice and pasta and bread. And we might think we're not going to have much sugar, but we're getting a lot of sugar.

And then of course, you know, if we want dessert, we're getting even more. So it's just there all the day and we're literally mainlining it all day long. And you know, I didn't really mention this earlier, Drew, but I'm working on a book called Young Forever about longevity and aging. And one of the key mechanisms of aging is our nutrient sensing systems. So we have these key systems in our body. I'll just name them, but don't get hung up on the names, CMPK, mTOR, and sirtuins, which are these master regulators of our biology and of aging, longevity. And they're governed by sensing the nutrients in

your bloodstream. So when you have high levels of sugar, it turns on all the wrong signals. It turns on all the signals of rapid aging and disease and death. When you actually get rid of the starch and sugar and you lower those inputs to those nutrient-sensing signaling molecules, you literally reverse all of the kind of signs and symptoms of aging. You know, we were talking about some mainstream cereals and foods that are out there and how they have a lot of added sugar, I think another area that's also useful for people that are typically a lot of listeners of your podcast, they may not have high fructose corn syrup, but they are filled with things like cassava flour and tapioca flour and these other things.

And they can have just as much, even though they're well-intentioned and I appreciate them trying to do that, but there's a cereal brand that I'm looking at right now. I'm not going to name any names. And it has, if you look at the amount of, you know, total net carbs in there, even though it doesn't have a lot of the junk that maybe Honey Nut Cheerios has, it still has the amount of same equivalent sugar inside of that. So even if somebody doesn't think, well, I'm not eating a lot of the processed foods that are out there. If you're eating a lot of these health brands, which have become very pervasive, this is still something that you want to pay attention to. And Mark, one of my favorite stories is that, you know, some of my

close friends, you know, all been having like babies in the last few years. And many of the women, many of the women who pay so much attention to their, their diet and their lifestyle were very surprised when they came back with a diagnosis of gest of gestational diabetes and, and they thought I'm eating really healthy. And it's just another reason why this is something that everybody should be paying attention to. You're so right, Drew, the, the pervasiveness of the starch and sugar diet and everything is so great. And all these healthy for you brands have come, nut milks, gluten-free desserts, you

know, alternative sweeteners. They're all attempts to try to deal with the fundamental problem in our culture, which is sugar addiction. So they want to swap out something that's really bad for something that's maybe a little bit better. But it turns out that, you know, gluten-free cake and cookies is still cake and cookies, right? If you're having a food that is full of refined, pulverized anything, even if it's a whole food ingredient, right? Pulverized whole wheat flour is still pulverized whole wheat flour. And that flour has a large surface area,

gets quickly absorbed. So whether it's cassava flour or happy oak flour or brown rice flour, I mean, you know, there's all these pastas now with brown rice and so forth. They're not that great. They're actually high glycemic foods. And they may be a little bit better. They may have a little more nutrients. It may be a little bit, you know, sort of better, but it's more like a wolf in sheep's clothing. And I think we need to be very conscious of the fact that we should be eating real whole food. It's really pretty simple. And I think we need to be very conscious of the fact that we should be eating real whole food. It's really pretty simple. And I, I, I, people, what do I eat? What do I eat? I mean, I've written a bazillion books on it, but at the end of the day, it comes down to

one question, which is, um, I came up with this when I was lecturing at this, at this church saddleback in California, which is, I was talking to Christian audiences. It's really simple to figure out what to eat. Ask yourself, did God make this or did man make this? Did God make a Twinkie? Yes. Did God make an avocado? Yes. Did man make an avocado? No. Like it's so easy to figure out what to eat if you just ask yourself a simple question, who made this? And if it's highly processed, if it's many steps from the field to the fork and you can't recognize what you're eating, it's an original form. You know, basically you pull a sweet potato by the ground, you put it in the oven, it's a sweet potato. Oh, it's a sweet potato. Or you get a piece of chicken, it's a chicken. I mean, yes, it's cut up, but it's like

you can kind of recognize it's a chicken as opposed to some weird chicken-like substance that I had when I was having one of those meals ready to eat, those MREs that the military eat when I was in Haiti. I was like, where's the chicken on the label? There's no chicken. It was a chicken-like substance. So I think we need to eat real whole foods and get rid of all those kind of things. And if we want a treat or sweet, make it yourself. Make it yourself. I mean, we have a food, what the heck should I cookbook, cookbook, book, whatever. And in there is a great recipe for halva, which is made from sesame seeds and nuts and got a little honey and sweetener. But it's actually good for you, even in small amounts.

And it's something you can make yourself. Now, we say people can eat whatever they want, as long as they make it themselves. If you want French fries, make it yourself. If you want a chocolate chip cookie, make it yourself. Yeah. And just to soften that a little bit, because having been friends with you and business partners over the years, it's not like you don't dabble in some of these other foods that are there. And it's not that you don't dabble in some of these other foods that are there.

And it's not that you don't eat out or that you don't get packaged foods from the grocery store. It's just that it's not the base of your diet. It's not the base. You're not eating it for breakfast, lunch, and dinner. When you're having it, it's as close to whole food ingredients that are part of it, right? Like you'll have occasionally like a protein powder that you'll use in your smoothies and other things. Great. I've made it in a factory, but you're looking at the ingredients inside of there. Those things are, uh, whole foods, largely ingredients that are ingredients that are, uh, that are a part of it. So Mark, this is a great opportunity to go into

the different types of sugar. Sugar has many different names and there's also artificial sweeteners that are out there that are not exactly sugar, but are trying to make up for that. And there's natural sweetener alternatives that are out there. So let's start off with the natural sweetener category. Break down some of the common natural sweeteners out there and what your take is on some of those popular sweeteners. Well, first of all, I'm just going to say that we should think about what Shakespeare said, which is a rose is but a rose by any other name. When it comes to sugar and all the different kinds of sugar, basically you need to think about them in much the same way, with a few exceptions.

Unlike fat, you know, there's trans fats, saturated fat, monounsaturated, polyunsaturated, all have profoundly different effects on your biology. Sugar is sugar is sugar, whether it's from honey or maple syrup, or whether it's from brown sugar or from, you know, refined sugar or sucanat or whatever, like all kinds of raw cane sugar, whatever, whatever, whatever, whatever. It's all pretty much the same. I'm going to give you a caveat around that. So that's really important to understand. You need to think about it as pretty much equivalent with a couple of exceptions. One is fructose. Now fructose is a naturally occurring sugar. It's combined in table sugar with glucose with a powerful bond. When you have high fructose corn syrup, it contains glucose and fructose, but there's more fructose. Up to 55% to 75% of the,

for example, high fructose corn syrup will be fructose, but it's free fructose. It's liberated. It's easily, quickly absorbed. And then when you have fruit juice or you have soda or you have things with high fructose corn syrup, it creates really profound changes in your liver that causes fatty liver, raises your triglycerides. It doesn't raise your insulin level. It doesn't raise your blood sugar directly, but it will do it indirectly and it will lead to even worse downstream consequences. So it's probably the most evil thing you could be consuming is high fructose corn syrup. That's a never consumed food. If I see anything with high fructose corn syrup, I never stick it in my mouth. Now, will I have an occasional small glass of fruit juice? Yes. But it's an occasional

treat and it's some kind of like passion fruit juice or something fun that I want to try. It's not a daily staple. If you're having fruit itself, yes, it's got fructose in it, but it's in the matrix of the fruit. So it's got fiber, vitamins, minerals, phytochemicals, things to offset, one, the rate of absorption and two, the downstream effects. So it's important to understand fruit is fine. Again, not eating pounds and pounds of fruit a day, but fruit as part of your normal diet. Now, what about maple

syrup or honey or agave, which sounds kind of cool, or table sugar or brown sugar? They're more or less equivalent. Honey is more fructose. Agave is almost pure fructose. So I would pretty much stay away from agave and put that in the high fructose category, high fructose corn syrup category, even though it's in all the healthy foods, it's considered healthy and natural. Just because it's natural doesn't mean it's healthy, right? Arsenic is natural, doesn't mean it's healthy. So we want to be very conscious about what we're consuming. And then if you're using those, I encourage you to use them when you're cooking food. If I'm making some special like Thai thing or something, I might want to put a tablespoon of brown sugar.

And I'll use coconut sugar because it's actually a little bit better. It's a little lower glycemic index. It's sort of marginally better, but it's not a free food. So coconut sugar is what I have in my house, for example, if I want to add sugar to a dish to flavor it somehow and I'm cooking. But I don't add a half a cup or a cup. I'll put a teaspoon or a tablespoon in. And in a whole dish, it's not very much. So, and do I have pancakes occasionally? Yeah. I mean, there's a pancake recipe in the Pekin Diet, which I love, from Himalayan tartary buckwheat, which is

the chai pancake, buckwheat pancake mix recipe. And yeah, I'll use a little maple syrup as a treat occasionally, probably two or three times a year, if that. So it's not that you never have it. It's just be very conscious about what you're doing and enjoy it, but don't make it a staple in your diet. Let's cover a couple other ones that are popular these days in this category of sugar alternatives. Let's start off with monk fruit and get your thoughts on monk fruit and then maybe like allulose, which is another sweetener that's popular. So monk fruit and allulose, and then we'll talk about the sugar alcohol categories next. Yeah. So there's a lot of artificial sweeteners,

right? I want to sort of touch on that because there's non-caloric sweeteners out there as a category. And that includes what you just mentioned, monk fruit, allulose, but also includes things like stevia, which is from a plant. It also includes aspartame and saccharin and sucralose and all these other artificial sweeteners. All the artificial sweeteners as a category, like aspartame, saccharin, and sucralose, have been shown to, one, alter the microbiome, which is the bacteria in your gut, in a way that causes you to gain weight. And two, in large studies have been shown to be associated with, now we can't prove cause and effect, but associated with obesity and diabetes. And it could be the people who are overweight drink more diet sodas because they're trying to lose weight, and that's why. But it seems to me there's more of a causative link based on some of the

mechanistic data we've seen. So basically, you want to stay away from that. Also, there's something called the cephalic phase insulin response. What that means is that when you are thinking about sugar, you release insulin. Now you're going, well, how could that be? Well, you've heard of Pavlov's dogs. He trained them, when they heard heard the bell to salivate because they knew they were going to get food. So he'd give them food, ring the bell, give them food, ring the bell. And then he'd ring the bell, no food, they'd still salivate. That happens to us. Essentially, when we ring the bell of sugar on our tongue with the artificial sweetener, it sends a message to our

brain, sugar's on the way. What does our body do? It kicks up insulin. Insulin is the fat storage hormone. Insulin makes you hungry. Insulin causes your body to put on that visceral fat and create inflammation and hormonal chaos and make you hungry and create all these diseases of aging. So they're not a free food. Monk fruit and allulose are typically better, and those are the ones I tend to use and recommend. Stevia can be okay for some people, but most of the stevia out there has been processed by Coca-Cola and Pepsi and Cargill in the form of Truvia or Pura Vida, which are an extract of stevia. They remove the bitter alkaloids, which actually may be beneficial from the plant, and they call it Reb A or Rebicide A. So you really don't want to have that. That's kind of

the artificial natural sweetener, if you know what I mean. They're the highly processed. So you want to stay away from those. Then what about sugar alcohols? Sugar alcohols are another category that people are using, whether it's erythritol, xylitol, melatonol. Those can be really problematic. They're large sugars. They don't get absorbed, so they taste sweet, but they don't actually go across your intestinal barrier. Now, when you are eating these sugars, if you have a microbiome that's not super healthy, which is probably most Americans, it causes fermentation of the sugars. So you end up basically with a brewery in your gut that can produce more disturbances and bad bacteria and bloating and distention and diarrhea. I mean, I personally had experience with that. This was

probably 20 years ago when these sugars were coming out on the market. And someone gave me a chocolate bar, which was a zero sugar chocolate bar. And I was seeing patients at Canyon Ranch in the afternoon and I ate the entire chocolate bar. I'm like, it's free food. It's chocolate. I can eat it. No sugar. And I ended up in the bathroom all afternoon, my stomach going crazy, bloating, distension, diarrhea, it was terrible. So you don't want to be doing that. So bottom line, if you're going to look for something sweet, eat real sugar. Have honey, maple syrup, coconut sugar.

Even a little regular sugar occasionally is fine. If you're wanting things to sweeten without any calories, try monk fruit or allulose. Stay away from the rest of the garbage. So Mark, as a physician, when you're working with a patient and you see that their metabolic health labs, and you can maybe touch on that just big picture, what some of the typical things are that you're looking for to see is this patient basically have excess sugar in their diet, not at a healthy, reasonable level. What do you look for? And then how do you get, begin the process of helping them treat that issue and any symptoms that might be related to it?

It's a great question. So as a doctor, one, I've learned I can literally look at people now and pretty much predict their lab tests by just looking at their body type, their body shape, and a lot of other subtle clues. It's sort of like blink. After you've seen tens of thousands of people with the same phenomenon, the same syndrome, you basically can tell what's going on. So when you're looking at lab tests, it's super helpful. They point to the emerging changes that happen over time when you start to eat too much starch and sugar. First, what happens is you start to see a rise in insulin. Now, most doctors never check insulin. It is the single most important test period that you can do to figure this out. Fasting insulin, yes, it's important. But the best test

is a sugar challenge followed by insulin measurements at 30 minutes, maybe one in two hours. If your insulin spikes, that means you are insulin resistant. That means your body's producing more and more insulin just to get your blood sugar down. That is going to drive a whole series of changes for often for decades before you even see your blood sugar go up. And then you'll see your blood sugar go up. And that may not be 70 or 80. It may be 95 or 100 or 110. You know you're in trouble. We also look at inflammation called C-reactive protein. We can tell people are more inflamed when they have metabolic syndrome or prediabetes. We look at their cholesterol. We see high triglycerides, low HDL. We see small cholesterol particles. We see oxidized LDL. And we see high uric acid. My friend David Perlmutter just wrote a book called Drop Acid,

which is not about psychedelic drugs. It's about uric acid, which is a phenomena that results from eating too much fructose in the diet and also sugar. And that creates all kinds of havoc and inflammation. We can also look at liver tests. We see fatty liver in elevations in liver tests. We see changes in kidneys. We see protein in the urine sometimes on tests. And then we see changes in hormones. For women, we see increases in certain hormones related to testosterone, which can cause facial hair and hair loss. And menstruating women can cause infertility and acne.

And they get high levels of something called D-E-H-E-A-S or dihydroandros, forget it. They have high levels of D-H-E-S. And in men, you can see low testosterone. I saw a guy yesterday who had a testosterone that was lower than most women because he was such a big dude and had such a big belly. His testosterone was 37 when it should have been 800 or 900. And, you know, anything under 200 is considered really bad. So he had the testosterone of a female, not even an old man. And so this is what happens when you start to eat too much starch and sugar, your whole metabolic pathways get into this chaotic pattern. And I've written a lot about this. There's a great

guide that's online called How to Work With Your Doctor to Get What You Need, where I list all the tests you can look at to see if you're eating too much sugar and what to do about it, what they mean. Yeah. And we'll link to that PDF in the show notes that anybody can find. Or talk about then, once you know where the patient is, talk about the typical protocol that you use to bring health back into their life. Well, honestly, Drew, I'm very embarrassed by what I do because I get paid a lot of money for really simple advice, which everybody should know and is kind of common sense. But it's eat real food and that's it. It's like, and what do I mean by that? Well, you want to eat food in its whole unprocessed state. You want to eat food that's low in starch and sugar. You want to dramatically cut or eliminate or avoid

flour and sugar from your diet. Does it mean never? No, it doesn't mean never. But it means if you're, for example, if you're 300 pounds and diabetic, yeah, it means never until you get your metabolism straightened out. Then you have more metabolic flexibility. For example, I have a fair bit of metabolic flexibility. You know, I went and played tennis yesterday really aggressively for an hour and I had a piece of halva, which is like a Mediterranean, Middle Eastern dessert with sesame seeds and honey and pistachios. So it's got like protein and fat, but it's got honey, but I got a little piece of it and it was fine because I had it after a meal and it was in the context of an overall meal that wasn't going to be absorbed very quickly. So you want to make sure

you're cutting out all the things that are driving it. Liquid sugar calories have to go. So one is what you cut out, starch, sugar, flour, liquid sugar calories, artificial sweeteners. Then what do you put in? You want a plant-rich diet. So what do you put in? You want a plant-rich diet, what I call the pegan diet, which is not plant-based but plant-rich, meaning most

of your diet should be plant foods, colorful plant foods, lots of fruits and veggies, nuts and seeds, a little bit of whole grains. Obviously, if you can do non-gluten, it's better, especially American gluten, some beans. If you're having dairy, have sheep or goat, it tends to be less hormonal and less inflammatory for many reasons. And if you're having animal food, make sure it's not raised in a factory farm. Make sure it's grown in a regenerative way, if possible, organic at the very least. And it's just eating real food. I mean, it's not so complicated. And when we do this, we see dramatic results, Drew. I mean, you know, I always tell the story of Janice because it's such a great story,

but I'm going to say it again because it's just so powerful. Here's a woman who was pretty well educated, but her family, her whole life, all they did was eat packaged processed food. She thought that was just what you ate. And even though she was very educated in one way, she was very uneducated about food. And she ended up slowly gaining weight and gaining weight and getting sicker and sicker and sicker. By the time she was 65, she had multiple stents in her heart. Her heart was failing. Her kidneys were failing. Her liver was failing. She had high blood pressure. She had diabetes. She was on insulin. And she was getting sicker and sicker and was on her way to a heart transplant, a kidney transplant. Within three days of changing her diet to just what I told you, which essentially is a whole foods,

plant-rich, low glycemic, anti-inflammatory, good fat diet with adequate amounts of the right kinds of protein. Within three days, she was able to get off her insulin. In three months, she was able to get off all her medications, which had a copay of $20,000. She was able to reverse her heart failure, reverse her kidney function that was abnormal, fix her fatty liver, normalize her blood pressure, and reverse her diabetes. Now, there is no drug on the planet that can do that. None. Like, she was on all the maximal drugs by the best doctors in the country, and it wasn't helping to stop or reverse the problem. It was just masking the symptoms. And so when you use food as medicine, you have the power to really radically transform this. I mean, even up to a few years ago, doctors were saying if you have type 2 diabetes, it could not be reversed. But now we're seeing reversal of beta cell

dysfunction, which is the cells in the pancreas that make insulin. We're seeing the renewal and recovery and repair of these insulin-producing cells so the body can actually start to regulate its metabolism naturally. It's really remarkable, Drew. I think we're in an extraordinary era, and repair of these insulin-producing cells so the body can actually start to regulate its metabolism naturally. It's really remarkable, Drew. I think we're in an extraordinary era, and we're seeing, for example, companies like Virta Health, which are using ketogenic diets, which is essentially 70% fat diets, to reverse diabetes in people who are pretty far along. And it works better than any treatment ever tested, and all the impact on the cardiovascular profile was beneficial. In other words, oh, you think, well, if you're going to eat

70% fat, it's going to screw up your cholesterol. No, it was the opposite. Because in this metabolic type, which is a lot of people, about 88% of Americans have some type of poor metabolic health, which is somewhere on the continuum of prediabetes, which is somewhere on the continuum of this dysfunction that happens with sugar and starch in your diet, they were literally able to completely reverse these dysfunctions. And I see it all the time in my practice. So it's tough because sugar is biologically addictive. So it's easy to say, stop heroin, but it's harder to do. And in fact, I'm going to be talking to a researcher about using a drug, which is in clinical trials for drug addiction called Ibogaine. It's from a West African bark of a plant, a tree that actually seems to reset the brain and shut off addiction.

And I'm very curious for America, if it could be in some form a treatment for sugar addiction and obesity because it stops that craving and that addiction. Powerful. The future is very bright and it starts off with us getting educated right now on all the things that we can do. Mark, this is the part of the podcast where we go into questions, our community, and we got a bunch of really great ones. So let's jump in.

So first question is, what about things like sweet potatoes and dates? Should we be mindful about the amount of sugars that are found in certain fruits or tubers in this instance? So the way I think about it is, what's your level of metabolic resilience and flexibility? And not to brag, but I'm 62 years old. I probably have 7% body fat. I have no belly fat. I exercise probably more than people want to know. I do a half an hour of strength training three or four times a week. I try to do an hour of cardio a day. I do other stuff too. I'm very active. And I eat a very whole foods healthy diet. So I have a larger

degree of metabolic flexibility than someone who is 400 pounds diabetic on medication whose system has been trashed. Now, the good news is that anybody can regain their metabolic flexibility at any age. It's harder to do if you're 400 pounds than if you're just a few pounds overweight, but it's possible. And we've seen it happen. It happened to Janice. So we know that this is possible. So I think the idea is that we want to encourage people to

focus on how they can gain a level of metabolic flexibility by improving their overall lifestyle habits. And it's all this stuff, right? It's a whole foods diet. It's exercise. It's getting up to sleep. It's learning how to de-stress. I actually had my continuous glucose monitor on, which was fascinating yesterday. And I played tennis, and I had really not eaten that much. I had a protein shake, and my blood sugar was like, you know, 80s, 90s. And after tennis, I was like, oh, I wonder what it is. And I was like, you know, it's like a toy. So I put a, check my levels, a glucose monitor. And I was like 146. And I'm like, holy crap, what the heck? How come my blood sugar is so high? And I texted Casey right away. I'm

like, what's going on? She's like, well, when you're exercising vigorously, you're releasing glycogen stores from your muscle for energy. Cause I'm like running around the court. Cause my coach is making me run like crazy. Cause his basically way of teaching is if I do something stupid, he hits the ball where I can't get it. And then I have to run really fast. I don't get back to the middle in time or whatever. He's like, kind of, that's how he teaches me. So I'm like going crazy over the court. And it was like the stress response and also the glycogen release led to high sugar. So I think, you know, but very quickly it came right back down to 90. So I'm fine.

So the more metabolic flexibility you have, the more resilient you are, the more wide you can make your diet. But if you are in a state of real metabolic inflexibility, you want to make sure you're adhered to a more restricted diet initially until you get the metabolic flexibility. So sweet potatoes, winter squash, they're great foods. I eat them. I actually have to eat sweet potatoes or else I'll lose too much weight, right? So I have to, I know I have to eat some carbohydrates. Otherwise, my body doesn't work properly. Other people don't and are carbohydrate intolerant. So I think sweet potatoes are fine if you have metabolic flexibility. So are small, like, like fingerling potatoes, other starches are fine. Root vegetables are fine. Beets, carrots, all that's fine. It's just volume. And if you're,

again, fruit is the same thing. If you're, if you're metabolically inflexible, you don't want to be eating a ton of fruit. You can have some berries, low glycemic fruit, that's okay. Have them in the context of protein and fat, okay. There's a really important concept called glycemic load because the glycemic index of a food is the amount that a certain amount of food will raise your blood sugar. So for example, white bread raises your blood sugar more than table sugar. So it's got a higher glycemic index. But what happens if you put nut butter or a piece of chicken or something on the bread? Well, it's going to change and you put a bunch of maybe psyllium seed on or something or flaxseed.

You're going to get fiber and protein and fat. Well, that's going to change the rate absorption of the sugar in the bread. So it really is a total composition of the meal that matters. And when I'm constructing a meal, I make sure I include a lot of fat, good quality protein, and lots of veggies. And then, yeah, I can add a little starch in there without getting into trouble. Fantastic. And I think the key with all this is personalization. And it's not that we can't, you know, even if we're minimizing certain foods, just like you said, there's plenty of hacks and you covered it on a bunch of podcast episodes recently that you've done, where as long as

you're having protein, fiber, and fat, and anybody can do this, whether you're a vegetarian, vegan, whether you're following more of a vegan diet, or anything else in between, you're having protein, fiber and fat, and especially before you have some of these other foods that are there, then you don't have to feel that things are as restrictive. You can still have a lot of the things that you enjoy. It's just a matter of sequencing. So it's important to realize that everybody's different. And an important study that was a landmark study done in Israel looked at the differences

in people's blood sugar and how it correlated to their microbiome. So they fed people the identical amount and type of food, and they found profoundly different changes in their blood sugar depending on their microbiome. That's just one factor. The truth is that there's many factors that regulate differences in how each person responds to exactly the same thing. For example, I am very insulin sensitive. If I drink a can of Coke, my blood sugar and insulin go like this. If I'm a Native American who's diabetic, it might go like this because they're genetically predisposed to pump out way more insulin given the exact amount of sugar.

So calories, not a calorie, is not a calorie. It's really important for you to understand. It depends on, one, the quality of the calorie, but it also depends on the individual who's consuming that calorie and what their metabolic state is. So it's very important to think about how to individualize this. As we're talking about this, Drew, I don't know if you can eat a sweet potato. I mean, you look like you could eat a sweet potato, but how do I know you can eat a sweet potato?

Well, guess what? We now have a technology called continuous glucose monitoring. Now, it's, I think, something everybody should do, not just those who are diabetic, but everybody should learn about their bodies. It doesn't mean you have to do it forever, but wear one for a few months or six months and see what you're eating and how to, oh, I have a plum and my God, my sugar went through the roof. But if I have a cantaloupe, I'm fine.

Or God, if I have, you know, black rice, I'm fine. But if white rice, it's through the roof. So you begin to learn how your body works. Or you have a sweet potato, you go, God, I can't eat a sweet potato. Or maybe a Japanese sweet potato is better than a regular sweet potato. Or maybe I can have a Peruvian purple fingerling potato, but I can't have a Yukon gold potato. So basically, you can learn your own body, and then you can start to match your diet to your own metabolic state and flexibility. Yeah. And then just going back to that same example you gave earlier,

you may be able to have all of those things you just put a little bit of you know you put a lot of fat you put a lot of fiber and you put things that slow down the rate at which these carbohydrates absorb into your body so you have less variability that's there so for anybody who's feeling worried that what are you saying that i can't have like a sweet potato? No, that's not what you're talking about. You're talking about figuring out the right way to have it. And then the amount of dosage that's there that's appropriate in the context of your entire diet. It's also true.

It's also true what you're eating when matters. So if you have a glass of wine or a slice of bread when you go to a restaurant before the dinner comes, you're screwed. Your blood sugar is going to spike. Your insulin is going to spike. You're going to gain weight. If you wait and you have a salad and some protein, olive oil, whatever, then have a glass of wine, then have a slice of bread, it might have a profoundly different effect on your biology and lead to not the same spikes in insulin and blood sugar and not the same metabolic consequences of weight gain and lipid problems and inflammation and everything else. Even though it's exactly the same food, exactly the same amount of food, it's when you eat it in the mix of a meal. That's great advice. Okay, next

question from our audience, Mark, is can you talk about fungus overgrowth in regards to sugar and carbs? Do they feed candida? Candida, yeast, fungus. Is there fungus among us? Well, yes, there is. And unfortunately, it's a big problem. But also, it's not as widespread of a problem as a lot of people think. People go, I have candida. I have this. I mean, most people don't have a big issue with it. We all have some yeast in our gut. But some people are more prone to overgrowth of fungal products in their gut. We call that SIFO, small intestinal fungal overgrowth. And it's a real problem. Now, some people walk around and you can spot them a mile away.

They're a walking mushroom. They have dandruff. They have white patchy scaly things on their skin. They might have vaginal yeast infections. They might have, you know, under their breasts or armpits, they might have yeast growing. So you can kind of tell. They've taken a lot of antibiotics, their breasts or armpits, they might have yeast growing. So you can kind of tell. They take a lot of antibiotics, eat a lot of sugar, flour, maybe they're on hormones,

they've taken steroids. All those are clues that they might have fungal problems. So when someone says, I've been on lots of antibiotics and I have this and I have that, I go, oh, well, maybe you have fungal overgrowth. Those people need to be careful. And one, we need to get rid of the source of food for the fungus. And what do they love to eat? Sugar. I mean, what is wine, right? What is bread? It's basically yeast that feed on sugar and it ferments. And that creates a lot of problems

for your biology. And the yeast produces toxic byproducts, creates inflammation, a host of other things. We're weight gain, fluid retention, irritable bowel. I mean, there's a long list of problems that can happen. However, for most people, it's really not an issue. Just cut down the sugar and starch, take probiotics. There's a special probiotic that helps to fight yeast called Saccharomyces bouillarde, which I love to use. It's a yeast, we call it yeast against yeast.

And it's great in keeping the bacteria healthy in your gut and keeping the yeast down. You can also use herbal antifungals that are available, oregano and many others. And sometimes you need prescription antifungals, depending on the patient. But in terms of diet, most people, if they're having a real fungal issue, they really should cut down on starch and sugar for a period of time, reboot their gut, and then they can add moderate amounts later. But it is a real problem for people, but it's not as widespread as people think. So the next question we have is what are your thoughts on how sugar affects the brain and does natural sugar and sugar alternatives like stevia and monk fruit, do they have the same addictive properties on the brain? First of all, sugar is not going to be right. Your brain on sugar is essentially a

depressed, demented brain, and also a hyperactive brain. All it takes is a parent to have ever gone to a kid's birthday party to tell you that. The kids are eating the cake and the ice cream, they're bouncing off the walls, and it's a bad scene. But the drivers of problems with brain and sugar are mediated through multiple pathways. A lot of it has to do with the insulin that I talked about before, and insulin resistance, and its effect on cognitive function over time. We know that when you eat a lot of sugar, it turns into creme brulee in your brain, and that creates crusts and amyloid and plaques, and this is what leads to Alzheimer's and dementia. So definitely bad for your brain. It's also been linked to depression, been linked to

tension deficit disorder. So it's really not a good thing for your brain. So in terms of the science of artificial sweeteners, there's still a lot to be done. I think we know for a fact that the true artificial sweeteners like aspartame and so forth, they do have really adverse neurologic effects. Stevia, monk fruit, allulose, I honestly don't think there's enough data to really determine whether or not they're seeing this cephalic insulin response, whether or not it's driving secondary consequences in our metabolic pathways that are driving inflammation and disease. It's hard to say. I've seen some preliminary data that makes me think they're not as bad.

But again, these are not free foods. Just because Stevie has no calories or Monk Fruit has no calories doesn't mean you just load it into everything. I prefer people to actually eat real sugar and know what they're eating and have a little bit. It's not the sugar you add to your food that's the problem. It's the sugar that's added by corporations. All right, Mark, this is the last question from our community before we go into a little bit of a recap of what we talked about today. So this audience member is asking us, I'm overweight and having a hard time with weight loss despite having average glucose levels in the 80s when wearing a CGM. What am I missing? Ah, beautiful question. That reminds me of this patient I had when I was at Kenya Ranch who taught me so much about metabolic function. Here was a woman who came in who was the classic

apple shape, round in the middle, skinny arms and legs. I thought she was going to be a metabolic disaster. She was classic shape of someone who has diabetes or prediabetes. I mean, enormous amount of belly fat. And I thought, man, her sugar is going to be off the chart. And you know what? It was normal. And we did a fasting blood sugar. It was perfect. And then I did a glucose tolerance test, basically giving her the equivalent of two Coca-Colas and measuring her sugar and insulin fasting and one and two hours later. Now, what happened was fascinating to me.

Her blood sugar was perfect, not even a little high. Like, it was in the 80s fasting, maybe 110 after two Cokes, which is normal, perfect. Her insulin, which should be under five and ideally even lower fasting and should never go over 20 or 30, was like 50 fasting and over 200 and 300 after one and two hours. So her insulin was so high, it was keeping her blood sugar normal. And it gave her the false sense that her blood sugar was fine, but she was a metabolic disaster. And so the insulin works in your body to keep blood sugar down until it doesn't work anymore. It's sort of like, you know, the boy who cried wolf. And, and you know,

once you just keep pounding and pounding and pounding sugar, the insulin goes up and up and up and up. And finally, it can't compensate anymore. And that's when your sugar starts to go up and you get diabetes. She wasn't at that stage, even though she looked like she was there. So even though your blood sugar is normal and you're not losing weight, it doesn't mean that you're okay. It means you should probably go and have a glucose tolerance test with insulin measurements, fasting one to two hours. There's something doctors really don't do.

You can also look at other indirect measurements that we talked about earlier, like your lipid particle size and liver function and kidney function and uric acid and many other things. So you can kind of get indirect clues. But my guess is that you're probably having very high insulin levels. And guess what? Starch will raise insulin. Sugar will raise insulin. Even too much protein will raise insulin. The thing that doesn't raise insulin is fat. So when you think about a type 1 diabetic, they have no pancreatic function. They can't produce any insulin. They're thin. When they present to you in the office, they usually have a classic triad of symptoms.

They're hungry and they eat everything in sight. They're thirsty because they're peeing out all the sugar and it's dehydrating them. And they're losing weight. So they're basically eating like crazy and losing weight. They can eat 10,000 calories a day and lose weight because they have no insulin. And guess what? Fat causes no insulin spike. And in the old days, Dr. Jocelyn, who the Jocelyn Diabetes Center was named for at Harvard, discovered that by treating diabetics with a ketogenic diet, essentially 70-75% fat diet, 5% carbs, and the rest protein, he was able to keep these

people alive and functioning because they could metabolize fats, but not sugars. So ideally, if you're having this problem, you want to be upping the fat and cutting the sugar and starch. Great. Great overview, Mark. Really appreciate that. I think this is a great time period to reflect a little bit on what we covered today on the topic of sugar. Let's chat about it. What do we big picture want to remind people about sugar? What do you want to say about sugar alternatives that are out there? And most importantly, what kind of message of hope do you want to leave for someone who feels like they have way too much sugar in their diet and might even be addicted to sugar? Well, the first thing I would say is that it's not your fault, that we live in a sea of sugar and starch, and that it's everywhere and in everything. So don't feel bad. However, if you

want to start to tackle this for your own biology, the most important thing to think about is how do you reset your metabolism? How do you regain your metabolic flexibility? And it's exactly as we've been talking about. The best way to do that if you're really stuck is use the 10-day reset or the 10-day detox diet, a book I wrote years ago, which essentially I've used in thousands and thousands of patients with remarkable results, and can really help to reset your brain chemistry so that you're not craving and hungry all the time. That's the first thing, because you don't want to be using willpower. You want to use science. The second thing is, you know, if you're thinking about net negotiating and can I have this? Can I have that?

Can I have, well, monk fruit? Can I have stevia? Can I, it usually means you're an addict. Okay. Like if you don't care, you don't care. You're probably not addicted. But if you're trying to figure out how am I going to deal, then that's a clue. And then you really should double down and get rid of all the artificial sweeteners, do the 10-day detox diet, and figure it out. And then, of course, eat in a way that actually keeps your blood sugar in balance, which is the Pegan diet or the 10-day reset or the 10-day detox. That's really powerful. And over time, you'll lose weight, your metabolism will become smarter, you'll regain more metabolic flexibility and resilience, and you'll be able to tolerate a wider range of foods without getting all screwed up. So that's really the take-home message here is that one, it's not your fault. Two, we're living in a sea of starch and sugar. Three, it's the cause of almost all known chronic disease and aging.

Four, artificial sweeteners are much better. And five, if you're going to use sugar, use stuff that you put in your food yourself, whether it's a spoonful of honey or maple syrup or whatever. Don't let corporations feed you sugar unwittingly. So Mark, really one of the things I want to mention here is that I've learned from you is the importance of metabolic flexibility. Because you've talked so much about sugar, it's easy to take your words out of context and say, well, Mark Hyman says, never ever eat sugar. Again, cut it all out, cut all the refined carbohydrates. And that's not what

you're saying. You're saying being smart about it, clean up your diet. And when the base of your diet is in a much better place, and maybe even get some of these metabolic markers done. I know you can order a lot of these tests through Levels now. They've actually offered that. We'll have the link in the show notes. Then you can partake in a way that if you have good sleep, the base of your diet is good, and you have moderate exercise that's there in the week, you can eat some of those

same foods that, yeah, they may not be in the same quantities, but you can still enjoy and partake in them and have them, especially with friends or making them at home. So that's really one of the main things that I've gotten for you and I've incorporated in my life. So thank you for that. Absolutely.

Thank you so much, Drew, for that conversation. I always love talking about sugar. For those of you listening, if you are inspired by this conversation and you liked what we had to say, share with your friends and family on social media, subscribe wherever you get your podcasts, leave a comment. How have you navigated your journey with sugar and what's worked for you? We'd love to know. And we'll see you next week on The Doctor's Pharmacy.

Hey, everybody. It's Dr. Hyman. Thanks for tuning into the doctor's pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements, to gadgets, to tools, to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays, nothing else, I promise. And all you do is go to drhyman.com forward slash PICS to sign up.

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