Hello and welcome back to The Ideal Nutrition podcast. My name is Aidan Muir and I’m here with my co-host, Leah Higl and this is episode 45, which we are going to be doing on sugar and fat loss/health, which is a really complex topic.
I don’t really know how to talk about this, because [00:00:30] it feels like a lot of what I’m going to say is going to be in defense of sugar in a way, in that I feel like a lot of people think it’s worse than it is or it’s bad under all contexts and stuff like that. Whereas I suppose what we’re going to touch on a little bit more is, I don’t want to call it devil’s advocate or anything like that, but it’s just what about when you have all these variables lined up like this? You’ll see that sugar itself is not a bad thing. It’s just that people who typically have higher sugar intakes also do a lot of other different things where they [00:01:00] have higher calorie intakes, they have lower micronutrient intakes and a whole bunch of stuff.
It’s going to be really complex. I don’t want to derail it too much. I want us to talk about stuff individually, so where do we want to start?
Let’s start with sugar and body composition. So in talking about this, sugar does not directly impact your body composition. We’re just talking about direct impact of sugar itself. So if you were eating at maintenance calories and majority of your carbs were coming [00:01:30] from sugar and everything else was the same, it’s not going to have a different effect on your body composition than if all of your carbohydrates were coming from whole grains.
Which I think is mind blowing. I do not think the general population knows that.
That’s true. It’s probably a topic that most people don’t… I guess they consider it, but they don’t think of it in that way.
Yeah. I know I certainly didn’t think about that before I started learning about nutrition. I just assumed that if you had 100 [00:02:00] grams of carbs from brown rice, actually let’s use a smaller number. 50 grams of carbs from brown rice versus 50 grams of pure sugar. The person having the brown rice is going to make way better body composition outcomes than the person having the sugar.
When we’re thinking about sugar and body composition, what really makes the difference is what we’re doing around that sugar intake. So let’s use that same example of having all of your carbs from sugar. You are more likely to over consume calories. [00:02:30] You’re more likely to have specific kinds of foods that are not super filling and it all comes down to calories in versus calories out at the end of the day. So while sugar doesn’t directly impact your body composition, given everything else is the same, in the real world, everything’s likely not going to be the exact same in those two scenarios. The person eating all the whole grains, probably going to eat less calories than the person eating all of the added sugar and that’s where the body composition stuff and changes and differences come into this discussion.
Yeah, for [00:03:00] sure. And the biggest game changer that I first saw was… I don’t know, when I first started lifting, I wanted to be in a calorie surplus and I found it hard to eat enough calories and I learned that fact and I was like, “Hang on. If I eat less sugar, I’m probably going to eat less calories.” It would be easy for me to get more calories in with more sugar and all those kind of things, whereas up until that point, I kind of assumed that, I don’t know, if I eat “cleaner”, I’ll make better progress.
Super complicated. But the study that is often referenced and we’re talking about in a previous podcast, [00:03:30] two podcasts actually, is Surwit et al from 1997, where they’ve compared 4% of total calories coming from sugar versus 40%, 10 times the amount, during a calorie deficit and they had similar outcomes for body composition. And I don’t know, even if you can find a minute difference, a tiny, tiny difference, it’s a hard argument when there’s such a vast percentage of calories coming from sugar in that example and there was just no difference. It was just so, [00:04:00] so similar. As you said, it is all that other stuff. If you’re eating more sugar, you’re probably eating more calories.
Yeah. You’re just having these highly palatable sweet foods that we tend to lean more towards over consuming.
So if you end up consuming more calories in total yeah, body composition stuff is going to change.
Yeah. And a little bit less relevant for body composition because that’s really, probably mostly what we’re going to touch on with the body composition kind of stuff, but a little bit less relevant than that, but more [00:04:30] for the health perspective. From a micronutrient intake perspective, even though it’s at the start of this I’m like, “Well, this might sound like I’m in defense of sugar.” There’s one real interesting line I’m about to say here we’re it’s every calorie you have coming from added sugar is a calorie that could have been spent on something that had micronutrients.
Added sugar doesn’t have vitamins and minerals or anything like that. If you have a high added sugar intake, you probably have a relatively low micronutrient intake coming through food. Obviously supplements is a different story because technically [00:05:00] you could have a really high sugar intake and then smash some multivitamins. But that’s a different topic that we’ll talk about at some other time.
And I guess leading on from that, let’s have a little discussion about added sugars generally versus the natural sugar discussion. So it goes back to that micronutrient intake thing with, if you have most of your sugars that you have coming in through your intake from natural sources, you’re probably going to be getting in some vitamin [00:05:30] C from fruit, some fiber, other micronutrients, which is obviously a healthy thing. But there really isn’t any chemical composition difference between the sugar… Well, there is a difference, but it’s not going to make a difference to your overall outcome in regards to sugar from something like fruit versus sugar from something like lollies.
That’s the difference is what’s coming alongside that sugar more so than what it actually is doing itself. [00:06:00] I really like the topic of raw desserts when we’re talking about this because I think they’re a great example of this marketing that is used in that they use the no refined sugars marketing. So instead of using regular cane sugar, they’ll use maple syrup or agave or things that are seen to be less processed, but that really makes no difference to the fact of what you’re eating. Usually raw desserts are just going to be, yeah, dates and coconut and coconut oil [00:06:30] and maple syrup and something like that. Is that any different to eating the same calories in cake from a micronutrient perspective? No.
It’s so minuscule. The micronutrients you’re getting from maple syrup versus cane sugar is just not even on our radar, so there really is no difference between the two in that context.
Yeah. Super interesting topic. I even see some really smart people in the nutrition space. It’s almost a bias to a certain degree, but they do hype up natural sugar versus added sugar or try [00:07:00] and make out there’s a huge difference but it is just that difference. The difference is the fiber and the difference is the micronutrients.
And in that example you just kind of talked about, there is no micronutrient difference. Sometimes you can argue about differences with honey and stuff like that.
There’s a prebiotic kind of benefit and stuff like that but that’s again, another complex topic, but sugar is sugar. But it’s a hard thing to say, because it’s also, as I said, the fiber is huge. You’re not going to overeat fruit as dramatically as you would something that contains that sugar [00:07:30] fat combo or whatever, because you’re going to get full before you overeat it to an extreme.
Yeah. And obviously fruit is healthier than lollies.
We’re not arguing that. We’re just saying that the sugar in the two things at the very baseline is the same.
Yeah, for sure. So one of the things that is a clear cut detriment to sugar is the health of our teeth. So if you look at a lot of governing health bodies and stuff like that when they’re trying to [00:08:00] make real evidence based statements, a lot of times they will actually say things along the lines of, “Sugar is not directly linked with any health outcomes outside of tooth decay.” Because that is one thing that is actually really clearly linked and that’s just because sugar interacts with bacteria within plaque to produce acid that slowly dissolves tooth enamel.
On that topic of governing bodies and stuff like that, World Health Organization have a strong recommendation of added sugar being less than 10% of total calories [00:08:30] to help reduce tooth decay and overweight/obesity. We kind of talked about the overweight and obesity thing, how it’s like, “Well, high sugar and intake means you’re probably going to eat more calories.” And then they also have a conditional recommendation of less than 5% of total calories coming from added sugar, which would come out as 25 grams of added sugar per day. One can of soft drink is about 40 grams of added sugar. So by that definition, you would not want to be having soft drink pretty much ever.
That kind of sugar.
Yeah. Which I agree with that for a lot [00:09:00] of cases, there will be some outlier cases like athletes and stuff like that, where maybe we would want to go slightly higher sugar than that in some rare cases. But before we go into all the other health outcomes, I do think it’s a pretty good guideline for most people to be sticking below at least that 10% of total calories coming from added sugar.
Makes sense. Let’s also talk about diabetes because this is one that comes up a lot.
The most popular one. Yeah.
In people going, “Oh, if you eat a lot of sugar, you’re going to end up getting diabetes.” And that is definitely an oversimplification of [00:09:30] what actually happens in regards to risk factors for Type 2 diabetes. One study that you brought up, I think perfectly encapsulates this. So it’s a large population level study that found the risk of developing Type 2 diabetes grew 1.1% per 150 calories of added sugar consumed per day over a 10 year period. That sounds like a lot but what that comes out to in context is about [00:10:00] 37 grams of added sugar per day for the 150 calories, so even when we’re thinking consuming four times that amount, so 150 grams of added sugar per day for a decade would only increase your risk of Type 2 diabetes by 4.4%.
Looking at that, the link there is not super strong in terms of just isolating sugar intake and Type [00:10:30] 2 diabetes risk. When it comes to Type 2 diabetes risk, the thing we’re mostly concerned about is weight gain, obesity and that causing insulin resistance, leading to the development of Type 2 diabetes. That’s one of the biggest risk factors. And we know people that usually consume a lot of added sugar probably are at a higher risk of weight gain and obesity because the foods that they’re consuming. So there’s an indirect [00:11:00] link, but to say that sugar causes Type 2 diabetes would be missing the mark.
Yeah. It’s a massive stretch. It is those other variables that are so, so, so much more linked with Type 2 diabetes.
Another one that is an interesting one is heart health, so cardiovascular disease. This is a really complex one, so I’m just going to go from the population level stuff and then come back to what actually matters, I guess, a more nuanced viewing of it. So from a population level, a 2014 study found that over [00:11:30] the course of a 15 year period, people who got 17 to 21% of their calories from added sugar had a 38% higher a risk of dying from cardiovascular disease compared with those who consumed 8% of their calories as added sugar. That’s a pretty huge difference and it looks pretty strong when you look at it from that perspective as well. The proposed mechanism that these authors came to conclusion was that sugar increased the risk of fatty liver and also had some potential inflammation mechanisms as well, which we’ll talk about inflammation a little bit later.
[00:12:00] Obviously as we kind of spoke about, if you eat a lot more added sugar, if your average intake of added sugar is 17 to 21% of your total calories, you’re probably going to be eating quite a lot more total calories, you’re probably going to have a lower micronutrient intake, you’re probably going to have a lower fiber intake, you’re probably not going to be doing many other health seeking behaviors as well, most likely. You’re probably going to be exercising less, getting less sleep, more stress, all those kind of things. So just because that is higher doesn’t necessarily explain it.
[00:12:30] But going through their mechanisms, so the risk of fatty liver, obviously everyone knows flaws in BMI, but I want to come back to BMI for a second, because at a population level, it is a decent measure of body fat and 80% of people who are in the obese class one category, so 30 to 35 BMI, have fatty liver. 90% of people in the obese class two have fatty liver. It is quite rare, it’s possible, but it’s quite rare for somebody who is relatively lean [00:13:00] to have fatty liver. You could get lean individuals with high sugar intake and they’re unlikely to have fatty liver still. Fatty liver is far more strongly correlated with our body fat levels, which as we talked about going back to that body composition stuff, sugar itself is not a major factor in our body composition. It’s total calorie intake, total macronutrient intake and sugar plays a role in that. But in isolation when you count other variables, it’s not really an issue.
Another study found that if calories were kept equal, replacing calories coming [00:13:30] from other carb sources with sugar up to 25% of total energy, which is quite high, in apparently healthy adults had no impact on cardiovascular disease. So once you take out all these other variables that I just kind of talked about and you just isolate the sugar variable, it has pretty much no link. The key word there though is apparently healthy adults. What if somebody already had Type 2 diabetes?
We just talked about how sugar doesn’t really increase the risk of Type 2 diabetes, but we know for somebody with Type 2 diabetes, if all other factors were kept [00:14:00] equal and they had the same total carbohydrate intake, they’d probably still want a lower sugar intake because it’s higher glycemic and if total carbs are the same and one version had lower glycemic versus one version at higher glycemic, is probably going to translate to differences in their blood glucose levels, which could then translate to risk of cardiovascular disease.
Once again, even in Type 2 diabetes, sugar in isolation in small to moderate amounts isn’t really an issue. But that’s why I use the word if total carbohydrate is matched. So yeah, interesting kind of topic [00:14:30] but it seems like in apparently healthy people without Type 2 diabetes, when all variables are matched, there isn’t really a link there, which once again, I think would surprise people.
Another thing that might surprise people is talking about cancer, so that’s our next topic.
Trying to smoothly kind of go into that one. So I heard this a lot on the cancer ward when I was actually a student dietician, in that people were really worried that sugar itself was going to feed cancer cells. So we [00:15:00] know generally cancer cells do grow more rapidly and replicate more rapidly obviously than regular cells and they do require a pretty large amount of glucose, so this is kind of where the misconception came from in that well, glucose, sugar, they sound pretty similar, obviously. So people are like, “Oh, if I consume a lot of sugar, I’m literally feeding the cancer cells and the cancer’s going to grow.”
But at the end of the day, glucose can be made from any of the calories that we [00:15:30] consume, it can be made from protein to a less efficient way as is fat, but it obviously can be produced through the calories coming in, regardless of whether that’s sugar or not. Specifically on the topic of sugar and cancer, the current consensus quoting the National Health and Medical Research Council on this topic. So the quote we have is, “Upon reviewing all available evidence, consumption of sugar is not associated with an increased risk of cancer. [00:16:00] There was sufficient evidence to conclude that there was no association between sugars and cancer of the pancreas, bowel, breast and bladder. There was no evidence of a direct association between sugar consumption and an increased risk of cancer of any type.”
So at the end of the day, there’s probably an indirect link in the fact that a lot of cancers are more likely when you are overweight and obese, so going back to that indirect link from sugar intake [00:16:30] and other behaviors those people tend to have. But when we’re just thinking directly, sugar intake and cancer? There’s no direct correlation.
Yeah. Once again, it’s one of those things when all other variables are equal, which they rarely are, but it’s really important to think through that lens, because what if you were to have a calorie and macro and micronutrient kind of equivalent diet and you want the flexibility of being able to have some sugar occasionally? This kind of stuff’s important.
And another topic on the cancer thing, because it is super, super nuanced. [00:17:00] But as you said, that glucose can come from protein, it can indirectly come from fat and it can come from complex carbohydrate forms as well. A way around that obviously is to go super low calorie and just not eat anything and that’s where people talk about fasting and stuff like that. But that’s a podcast in itself.
Yeah. It’s not directly sugar, but it is a complex topic. So what we are going to talk about and I’m going to put this all together in one section, so gut health and inflammation is another complex topic but it’s worth mentioning. [00:17:30] So research has linked high intakes of sugars with an increase of the relative abundance of Proteobacteria in the gut, which is typically considered bad, while simultaneously decreasing the abundance of a lot of population groups of bacteria that we typically consider to be good. And this linkage is considered to upset the balance of the microbiota and also have increased pro-inflammatory properties, which is where a lot of the proposed inflammation comes from.
From a gut health perspective though, this is a really tough one because we know [00:18:00] that focusing a wide variety of high fiber, plant-based foods does the opposite of this and it’s a really complex topic because is sugar causing this issue? Or is the lack of fiber in terms of quantity and variety causing this? Because all of the research that I’m aware of in this topic that has high sugar intake often also has high saturated fat intake and low fiber. It’s the typical standard Western diet. It’s not exactly like they’ve matched the variables like we talked [00:18:30] about in all the other areas. Where it’s kind of like, “Yeah, well what if we have relatively high sugar intake but we have high fiber, we have high plant based foods?” All of these kind of things. So it is an interesting one.
Moving on to the other perspective though, where we do actually have far more research because gut health is a bit like of a newer space. The way I view it, just summarizing and I guess I would say that like, “Hey, if you want to improve gut health, probably reduce your added sugar intake.” I’d probably still do it because it’s indirectly going to… It doesn’t matter which one’s causing it. It doesn’t matter whether it’s the fiber, whether it’s the sugar, whether it’s whatever. Indirectly reducing [00:19:00] sugar intake’s probably going to lead to increasing your fiber intake as well.
But from the inflammation perspective, greater sugar is often linked with inflammation in the research. But when it is studied in the absence of a calorie surplus, it’s not linked with inflammation anymore. The majority of research where calories are equated also shows no noticeable differences between inflammatory markers, between a high glycemic index diet and a low glycemic index diet, which is typically going to be a high sugar [00:19:30] diet versus a low sugar diet. And this has been well studied, so when you account for all the variables, there’s no difference in inflammation in terms of the markers that we can measure with blood tests and stuff like that.
So last and final thing we’re going to quickly touch on is acne and skin health. So there is a link between consuming high GI foods, so such as sugar, and that being linked with acne, but it’s not a really strong link. There are so many things that could affect skin health and acne [00:20:00] that aren’t sugar, but it’s one of those things that could be considered and might be an issue for some people. Do you want to leave it there in regards to acne?
I think so because it is true. Higher GI foods are typically linked with acne. That is true, but it is a weak link. It’s just a possible link. And the amount of people I have seen obsessing over their diet to clear up acne when it’s unrelated is really tough to watch for years and years and years. [00:20:30] I’m just going to name dieticians. There’s heaps of dieticians who I see who clearly care about their skin health far more than I do. I don’t care about it, but they care about it and they have not found a solution because it’s not as simple as just cutting out sugar for a lot of people. Some people it is. Other people it’s probably not.
Yeah. And acne is one of those things, it’s so complex and there could be so many things to feed into why it’s there that I understand why people are so desperate to fix it, because if it’s really bad, that can affect your life so [00:21:00] much and your self confidence, so I definitely understand that. But I think recognizing that it isn’t a super strong link and it’s obviously not going to be a thing for everybody is important.
It’s a tough topic to discuss generally talking about… We’re not talking about the pros of sugar, but I guess we’re trying to clear up misconceptions that people often have around sugar itself. Obviously we don’t want people going out and consuming a whole heap of added sugars. Ideally for most people [00:21:30] we should limit it. It’s going to make it easier to over consume calories. It doesn’t come alongside those micronutrients and fiber that we talked about that natural sugars would. And it usually displaces other foods in your diet that could be more nutritious and have more of benefit to your health overall. But when we’re thinking direct effects of sugar, list is pretty short outside of potentially acne for some people and the tooth decay stuff.
So those are, [00:22:00] really, the direct links that we do have. So yeah, the key takeaways here is not to go out and consume a bunch of sugar, but it’s probably okay in moderation and let’s not freak out about it.
Yeah, agreed. And that’s exactly how I view it. Once again, I personally do not have much added sugar. My clients, my plans, very rarely have much added sugar. It’s quite rare for there to be much added sugar in there at all. I’m a big proponent of a nutrient rich diet, which regardless on what calories are on, whether you are in a calorie surplus or [00:22:30] a calorie deficit, you can get more micronutrients in if you’re focusing on micronutrient rich foods, which by definition means you’re probably not having much added sugar. So yeah, that is how I think about things but it is just important because it gives you flexibility, understanding all these things.
It means that within the context of a calorie, macro micronutrient appropriate diet, you can have sugar occasionally and still get incredible results. You can still achieve everything you want to achieve, which in a world of disordered eating and everything like that is an absolute blessing [00:23:00] for this to exist and this to be a possibility.
So yeah, I think this is super important information, which is why I want to talk about it. It is a complex topic to talk about it. I don’t like talking about it, but I feel like this podcast, this long form content, is probably the best place to have some form of conversation about it and hopefully it helps a few people.