Sugars in your food

Over the past fifty years, their consumption has tripled among the general population in Europe and North America, leading to serious health consequences.

Coincidentally, following this incline in sugar consumption is the prevalence and severity of its associated diseases. Fatty liver disease, nefropathies, high blood pressure and diabetes have risen drastically during the same period.

Incidences of sugar related diseases

The incidence of non-alcoholic fatty liver disease (NALFD) among adults was 26% in studies conducted earlier than 2005, 38% in studies from 2005 to 2022, and are predicted to exceed 45% by 2040 if the trends continue. This means that every third adult person in the world has problems with a dysfunctional liver today, and every second adult person in the world is going to suffer from NALFD by 2040.

Since 1990 the number of people worldwide with hypertension has doubled, from approximately 600 million to more than 1.2 billion people nowdays. Despite treatment and diagnosis being readily available, even the incidence of undiagnosed and untreated patients is rapidly growing year after year. 

Figure 1: Number of people with hypertension over the years, overall and in separate regions of the world.

In 2022 more than 14% of all adults were living with diabetes, and only less than half of them (41%) were properly medicated. This number is again double of that in 1990, where only 7% of adults worldwide were affected by it. In 2021 diabetes was the direct cause of 1.6 million deaths and 47% of all deaths due to diabetes occurred before the age of 70. Another 530 000 kidney disease deaths were caused by diabetes, and high blood glucose causes around 11% of overall cardiovascular deaths worldwide.

While urbanization could have had a role in elevated incidence of all of the aforementioned conditions, it could not have amounted for such drastic raise in such a short time alone. Food and alcohol being more readily and cheaply available does contribute as a factor, but the main culprit for such high rates is the added sugar in almost every processed food item.

Moreover, the most alarming fact is the almost tenfold rise in the onset of neonatal diabetes not tied to genetic disorders, from 1970s to today! Newborns are being diagnosed with elevated blood sugar acquired during pregnancy and lactation.

Sugar in grocery stores

In 1965 Fred Stare, head of the department of nutrition, and Mark Hegsted, later the head of the USDA in 1970, were paid to produce two articles for the New England Journal blaming saturated fats for the rapidly declining public health in the USA. The consumption and addition of sugar in food has been rising ever since. Among the listed public health issues were high blood pressure, non-alcoholic fatty liver disease and diabetes. These articles and their findings have since been revisited and revoked.

When it comes to sugar, more than 70% of items in grocery stores in Northen America and more than 55% of items in Europe are misbranded, mislabelled or otherwise falsely advertised. Terms such as sugar free, dietary, no added sugar, sport, healthy and similar are being proudly presented over those items, where in fact, sugar has been added in other forms. There are over 250 names for added sugar the food industry uses to sidestep such claims: apple puree, raspberry puree, cane juice, maltose and fruit juice are just some of those names, which elevate our blood sugar all the same. The food with no added sugar instead has added apple puree... Which has added sugar.

While most of the excess sugar comes from food items, beverages amount to 33% of excess sugar. One sugary beverage per day riases the chance for the onset of diabetes by 29%! Even the dietary beverages with zero calories have the toxicity and the raising chance for diabetes roughly half that of a normal sugary beverage, meaning two diet beverages also raise the chance of diabetes by 29%. Despite having no calories, meaning our body can't metabolize it into energy, artificial sweeteners such as aspartame, saccharin or sucralose still elicit the same insulin response as glucose. The tongue senses something sweet, the signal travels to the brain and it employs the pancreas to produce insulin.

Insulin is a growth factor, and while it is the primary regulator of blood glucose, its overexpression (like when eating too much sugar) vastly contributes to heart diseases and various types of cancer. Diabetics have a much bigger incidence of heart attack, cancer and dementia, on top of other diseases.

The importance of glucose in the body

Our body has the innate ability to process glucose and fructose. Glucose is necessary for the brain to function, as well as for several hormones to work as intended. The process of glicosilation binds glucose to the hormone molecules, modifying their activity levels.

In fact, glucose is so important that the body makes its own, in case of glucose shortage. The process is called gluconeogenesis and is a common way to regulate glucose levels in blood and in organs when we don't intake enough of it with diet. For most of our evolutionary lifespan it has been the main, and sometimes the only way of producing glucose.

Fructose, on the other hand, is not necessary for the function of the body and can't be made de novo. However, it is the main ingredient in table sugar and the most prevalent type of sugar in any food with added sweetness, and also in some foods who claim otherwise. Caster sugar, table sugar or just sugar are all names for succrose – a glucose and a fructose molecule bound together. It is cheap, sweet and easy to produce from readily available sources.

However, fructose is in the human body metabolized the same way alcohol is, and in the same amount. Our liver has the capacity to metabolize up to 12 grams of fructose per day, or roughly 24 grams of table sugar. The average consumption of sugar in food in the western society exceeds 100 grams per day. That is more than 50 grams of fructose, or more than quadruple the amount our liver can break down.

Both glucose and fructose have the energy density of 4 kcal per gram, but the mitochondrial pathways of breaking them down are vastly different. While glucose stimulates the work of AMP kinase, a protein responsible for producing energy in the form of ATPs, fructose inhibits both it and CTP1, one of the main proteins in mytochondrial function, leading to the raised levels of insulin, without any energy being produced. And since the average consumption of sugar vastly outpaces the liver's ability to digest it properly, it becomes toxic to the body.

How the sugar toxicity and insulin levels affect the body will be covered in a future article.

Figure 2: Reduction of total dietary sugar and its benefits in children.

The rising cost of cheap food

Both the agricultural advances and food processing procedures have made food cheaper and more affordable than ever before. In a race to obtain as much market share as possible in a tight race, food producers have gradually started making their food tastier, sweeter and ultimatively more addictive. The unfortunate consequence is the increasing amount of sugar in almost every processed food, which in turn causes a slew of health problems. The medical cost of consuming such food worldwide exceeds 16 billion dollars per year in drugs and treatments alone.

Even though many laboratories and companies are actively working on developing drugs against such problems, with some promising achievements already in clinical trials, the root of the problem is widely being ignored, or, in the best scenario, sidestepped. The cost of cheap processed food is expensive medication and lifelong medical treatments.

References:

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7.     Rodriguez LA, Madsen KA, Cotterman C, Lustig RH: Added sugar intake and metabolic syndrome in US adolescents: cross-sectional analysis of NHANES 2005-2012. Public Health Nutrition 19:2424-2434, 2016.

8.     Teng ML, Ng CH, Huang DQ, Chan KE, Tan DJ, Lim WH, Yang JD, Tan E, Muthiah MD. Global incidence and prevalence of nonalcoholic fatty liver disease. Clin Mol Hepatol. 2023 Feb;29(Suppl):S32-S42. doi: 10.3350/cmh.2022.0365. Epub 2022 Dec 14. PMID: 36517002; PMCID: PMC10029957.

9.     https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/artificial-sweeteners/art-20046936

10.  https://www.youtube.com/watch?v=4DWKf5RqU-s&t=6546s

11.  https://www.who.int/news-room/fact-sheets/detail/diabetes