One of my patients - who had struggled with obesity, uncontrolled diabetes and the cost of her medication - agreed in June 2019 to take a more plant-based diet for whole foods.
She was excited about the challenge and did a remarkable job. She increased her intake of fresh fruits and vegetables, stopped eating sweets, cookies and cakes and cut back on foods from animal sources. Over the course of six months, she lost 19 pounds, and her HbA1c - a measure of her average blood sugar - dropped from 11.5 to 7.6 percent.
She was doing so well that I expected her HbA1c would continue to decline and she would be one of our plant-based successes that had reversed diabetes.
Her three-month follow-up visit in March 2020 was canceled due to COVID-19 lockdowns. When I finally saw her again in May 2021, she had gained some weight and her HbA1c had risen to 10.4 percent.
She explained that her diabetes doctor and a diabetes nurse had told her that she ate too much "sugar" on the plant-based diet.
She had been advised to limit carbohydrates by cutting back on fruits and starchy vegetables and eating more fish and chicken. Sugar-free sweets, cakes, cookies and artificial sweeteners were encouraged. In the face of conflicting medical advice, she fell back on conventional wisdom that "sugar" is bad and should be avoided whenever possible, especially if you have diabetes.
I am a physician, board certified in preventative medicine with a lifestyle medicine clinic at Morehouse Healthcare in Atlanta. This new medical specialty focuses on helping patients change healthy lifestyle behaviors.
Patients who adopt plant-based whole-foods increase carbohydrate intake and often see reversal of chronic diseases, including diabetes and hypertension. In my clinical experience, myths about "sugar" and carbohydrates are common among patients and healthcare professionals.
Fruit vs. sugar
Your body is running on glucose. It is the simple sugar that cells use for energy.
Glucose is a molecular building block of carbohydrates, one of the three essential macronutrients. The other two are fat and protein. Starches are long, branched chains of glucose.
Over: These molecules - glucose, fructose and galactose - are the three kinds of simple sugars found in starch, fruit and milk.
Naturally occurring carbohydrates rise in nutrient-dense packages such as fruits, vegetables, whole grains, nuts and seeds.
Over: Chains of simple sugar molecules bound together form starch and other carbohydrates.
Humans evolved to require sweet taste to get the nutrients needed to survive. A daily supply of vitamins, minerals and fiber is necessary because our body cannot make them. The best source of these drugs for our ancient ancestors was sweet, ripe, delicious fruit.
In addition, fruits contain phytonutrients and antioxidants, chemicals produced only by plants. Phytonutrients such as ellagic acid in strawberries have anti-cancer properties and promote heart health.
Refined sugar, on the other hand, is highly processed and deprived of all nutrients except calories. They are a concentrated form of carbohydrate. The food industry produces refined sugar in many forms. The most common are sucrose crystals, which you will recognize as table sugar, and high-fructose corn syrup, which are found in many processed foods and sweetened beverages.
If you constantly satisfy your taste too sweet with foods that contain refined sugar - rather than the nutritious fruits that are at the heart of this urge passed on by evolution - you may not get all the nutrients you need.
Over time, this deficit can create a vicious circle of overeating that leads to obesity and obesity-related health problems. Women who eat the most fruit tend to have a lower incidence of obesity.
Refined sugars are not directly toxic to cells, but they can be combined with proteins and fats in foods and in the bloodstream to produce toxic substances such as advanced glycation end products (AGEs). High blood sugar levels can produce glycated low-density lipoproteins. High levels of these and other glucose-related toxins are associated with an increased risk of a wide range of chronic health problems, including cardiovascular disease and diabetes.
The disease most commonly associated with sugar is type 2 diabetes. A surprising number of people, including healthcare professionals, mistakenly believe that eating sugar causes type 2 diabetes. This myth leads to a focus on lowering blood sugar and "counting carbs" while ignoring the real cause: progressive loss of pancreatic beta cell function. At diagnosis, a patient may have lost between 40 and 60 percent of their beta cells, which are responsible for producing insulin.
Insulin is a hormone that controls the amount of glucose in the bloodstream by blocking glucose production in the liver and driving it into fat and muscle cells. Loss of beta cell function means that not enough insulin is produced, resulting in the high blood sugar levels that are characteristic of type 2 diabetes.
Beta cells have low levels of antioxidants and are susceptible to attack by metabolic and diet oxidized free radicals and AGEs. Antioxidants in fruit can protect beta cells. Researchers have found that consuming whole fruits reduces the risk of type 2 diabetes, with those who eat the most fruit having the lowest risk.
Detoxification from sugar
People who are interested in losing weight and improving their health often ask if they should do a "sugar detox". In my opinion, this is a waste of time because it is not possible to remove sugar from the body. For example, if you only ate baked chicken breast, your liver would convert protein into glucose in a process called gluconeogenesis.
Low-carb diets can lead to weight loss, but at the expense of health. Diets that significantly reduce carbohydrates are associated with nutrient deficiencies and higher risk of death for whatever reason. On ketogenic diets with low carbohydrate content, the body will break down muscle and convert their protein into glucose. The lack of fiber causes constipation.
Eliminating foods sweetened with refined sugar is a worthy goal. But do not think of it as a "detox" - it should be a permanent lifestyle change. The safest way to go on a refined sugar "detox" is to increase your intake of nutrient-dense fruits and vegetables. Once you have removed refined sugar, you will probably find that your taste buds become more sensitive to - and appreciate - the natural sweetness of the fruit.
Jennifer Rooke, Assistant Professor of Community Health and Preventive Medicine, Morehouse School of Medicine.
This article is republished from The Conversation under a Creative Commons license. Read the original article.