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Kindle Notes & Highlights
by
Jason Fung
Diabetes correlates with sugar, not calories.
Yes, cavities. There seemed to be no concern that eating more sugar would raise blood sugar. Even in 2014, the American Diabetes Association website stated that “experts agree that you can substitute small amounts of sugar for other carbohydrate-containing foods into your meal plan.”12
But perhaps the fattening effect of sugar is due to its nature as a highly refined carbohydrate.
GLUCOSE, A SUGAR with the basic molecular structure of a six-sided ring, can be used by virtually every cell in the body. Glucose is the main sugar found in the blood and circulates throughout the body.
However, it was recognized long ago that this classification provided little physiologically useful information, since it only differentiates based upon the chain length. It
For example, white bread, which is composed of complex carbohydrates, causes a very quick spike in blood sugar, almost as high as a sugar-sweetened drink.
Glucose was given the value of 100, and all other foods are measured against this yardstick. Bread, both whole wheat and white, has a glycemic index of 73, comparable to Coca-Cola, which has a value of 63. Peanuts, on the other hand, have a very low value of 7.
Furthermore, it should be noted that the glycemic index measures blood glucose, not blood insulin levels.
WHERE DOES FRUCTOSE fit in? Fructose does not raise the blood glucose appreciably, yet is even more strongly linked to obesity and diabetes than glucose.
Fructose was previously considered a benign sweetener because of its low glycemic index. Fructose is found naturally in fruits, and is the sweetest naturally occurring carbohydrate. What could be wrong with that? The problem, as often is the case, is a matter of scale. Natural fruit consumption contributed only small amounts of fructose to our diet, in the range of 15 to 20 grams per day. Things began to change with the development of high-fructose corn syrup.
High-fructose corn syrup, however, could be processed from the river of cheap corn that was flowing out of the American midwest—and that was the decisive factor in favor of high-fructose corn syrup. It was cheap.
•has a low glycemic index. Soon, high-fructose corn syrup found its way into almost every processed food.
The tide began to turn in 2004 when Dr. George Bray from the Pennington Biomedical Research Center of Louisiana State University showed that the increase in obesity closely mirrored the rise in use of high-fructose corn syrup.
THE DANGERS of dietary fructose received increased scrutiny, researchers scrambled to investigate. Glucose and fructose differ in many significant ways. Whereas almost every cell in the body can use glucose for energy, no cell has the ability to use fructose.
fructose is targeted like a guided missile to the liver.
The bottom line is that excess fructose is changed into fat in the liver. High levels of fructose will cause fatty liver. Fatty liver is absolutely crucial to the development of insulin resistance in the liver.
So only six days of excess fructose will cause insulin resistance. By eight weeks, pre-diabetes is establishing a beachhead. What happens after decades of high fructose consumption? Fructose overconsumption leads directly to insulin resistance.
If insulin levels start to drop, the stored fat and sugar comes whooshing out. To compensate, the body keeps raising its insulin levels. Thus, insulin resistance leads to higher insulin levels. High insulin levels encourage more storage of sugar and fat in the liver, which causes even more over-cramming of fat in the already fatty liver, causing more insulin resistance—a classic vicious cycle.
stimulate both insulin and insulin resistance. The extra fattening effect of sugar is due to the stimulation of insulin resistance from fructose, which festers for years or even decades before it becomes obvious.
Sugar’s effects, as well as obesity, develop over decades, not days.
This explains the apparent paradox of the Asian rice eater. The INTERMAP studies of the 1990s found that the Chinese were eating very high amounts of white rice, but suffered little obesity. The key was that their sucrose consumption was extremely low, which minimized the development of insulin resistance. Once their sucrose consumption started to increase, they began to develop insulin resistance.
YOU WANT to avoid weight gain, remove all added sugars from your diet. On this, at least, everybody can agree. Don’t replace them with artificial sweeteners—as we’ll see in the next chapter, those are equally bad.
laboratory, he tasted everything in sight. He had just discovered saccharin, the world’s first artificial sweetener.
ORIGINALLY SYNTHESIZED AS a drink additive for diabetics, saccharin’s popularity slowly spread,1 and eventually other sweet, low-calorie compounds were synthesized.
Aspartame (NutraSweet), was discovered in 1965. Approximately 200 times sweeter than sucrose, aspartame is one of the most notorious of sweeteners, due to its cancer-causing potential in animals. Nevertheless, it gained approval for use in 1981. Aspartame’s popularity has since been eclipsed by acesulfame potassium, followed by the current champion, sucralose.
Diet drinks contain very few calories and no sugar. Therefore, replacing a regular soft drink with a diet soda seems like a good way to reduce sugar intake
From humble beginnings in 1960 to the year 2000, the consumption of diet soda has increased by more than 400 percent. Diet Coke has long been the second most popular soft drink, just behind regular Coca Cola.
The next big thing to hit the market was stevia. Stevia is extracted from the leaves of Stevia rebaudiana, a plant that is native to South America.
If diet drinks substantially reduce obesity or diabetes, why did these two epidemics continue unabated?
She found that instead of reducing the obesity, diet beverages substantially increased the risk of it by a mind-bending 47 percent.
Dr. Hannah Gardener from the University of Miami found in 2012 that drinking diet soda was associated with a 43 percent increase in risk of vascular events (strokes and heart attacks).
Despite reducing sugar, diet sodas do not reduce the risk of obesity, metabolic syndrome, strokes or heart attacks. But why? Because it is insulin, not calories, that ultimately drives obesity and metabolic syndrome.
The important question is this: Do artificial sweeteners increase insulin levels? Sucralose13 raises insulin by 20 percent, despite the fact that it contains no calories and no sugar. This insulin-raising effect has also been shown for other artificial sweeteners, including the “natural” sweetener stevia. Despite having a minimal effect on blood sugars, both aspartame and stevia raised insulin levels higher even than table sugar.14 Artificial sweeteners that raise insulin should be expected to be harmful, not beneficial. Artificial sweeteners may decrease calories and sugar, but not insulin.
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The incomplete activation could stimulate cravings for sweet food to fully activate the reward centers. In other words, you may be developing a habit of eating sweet foods, leading to overeating. Indeed, most controlled trials show that there is no reduction in caloric intake with the use of artificial sweeteners.17
Does drinking diet soda make any difference to adolescent obesity? The short answer is no. There was no significant weight difference between the two groups.
THE FINAL ARBITER, therefore, must be common sense. Reducing dietary sugars is certainly beneficial.
of
Caloric reduction is the main advantage of artificial sweeteners. But it is not calories that drives obesity; it’s insulin. Since
“The best lifestyle for heart disease is the one you can follow.” Unfortunately, many so-called experts in obesity profess this exact sentiment.
The truth is that there are multiple overlapping pathways that lead to obesity. The common uniting theme is the hormonal imbalance of hyper-insulinemia. For
For others, the main problem may be insulin resistance. Changing meal timing or intermittent fasting may be most beneficial. For still others, the cortisol pathway is dominant.
In cardiovascular disease, multiple drug treatments work together. We use drugs to treat high blood pressure, high cholesterol, diabetes and smoking cessation—all at the same time. Treating high blood pressure does not mean ignoring smoking.
The same approach is necessary to address the multidimensional problem of obesity. Instead of targeting a single point in the obesity cascade, we need multiple targets and treatments.
STEP 1: REDUCE YOUR CONSUMPTION OF ADDED SUGARS
SUGAR STIMULATES INSULIN secretion, but it is far more sinister than that. Sugar is particularly fattening because it increases insulin both immediately and over the long term.
Many natural, unprocessed whole foods contain sugar. For example, fruit contains fructose, and milk contains lactose. Naturally occurring and added sugars are distinct from one another. The two key differences between them are amount and concentration.
First, sugars may be added in unlimited amounts. Second, sugar may be present in processed food in much higher concentrations than in natural foods.
For these reasons, we direct most of our efforts toward reducing added, rather than natural sugars in our diet.
Read the labels Almost ubiquitous in refined and processed foods, sugar is not always labeled as such. Other names include sucrose, glucose, fructose, maltose, dextrose, molasses, hydrolyzed starch, honey, invert sugar, cane sugar, glucose-fructose, high fructose corn syrup, brown sugar, corn sweetener, rice/corn/cane/maple/malt/golden/palm syrup and agave nectar. These aliases attempt to conceal the presence of large amounts of added sugars.
Spaghetti sauce may contain as much as 10 to 15 grams of sugar (3 to 4 teaspoons). This counters the tartness of the tomatoes, and therefore may not be immediately evident to your taste buds.
