Do you struggle with cravings for sweets? What do you do to curb the cravings?
Sugar is sneaky. It goes by many names. Like high fructose corn syrup, fructose, sucrose, rice syrup, turbinado sugar, raw sugar, agave, maltose, dextrose, and many others. We already know high sugar consumption is associated to chronic inflammatory diseases like type 2 diabetes and cardiovascular disease to name a few.
More research is finding links to high sugar consumption and arthritic joint diseases. Hu et al in 2014 showed an associated increased risk of Rheumatoid Arthritis (RA) in women who drink sugar-sweetened soda (including regular cola, caffeine free-cola and other sugar-sweetened carbonated soda). They followed over 80,000 women over 20 years. They collected validated food-frequency questionnaires at baseline and every 4 years during follow-up. They found that regular consumption of sugar-sweetened soda (greater than one soda per day compared to less than one soda per month) is associated with increased risk of seropositive RA, independent of other dietary and lifestyle factors..
In addition to your joints, sugar consumption can affect your brain as well. Sugar sweetened beverages, coffee or tea is also associated with higher risk of depression in older US adults, but unsweetened tea and coffee may actually decrease the risk of depression.2
How much is ok if you can’t avoid it 100%?
That’s a tough question to answer. It’s really a personal answer. Perfection is never the key in life, but soaring thru life is the goal.
If you are healthy, with no medical conditions, you aren’t recovering from an injury, do not suffer from inflammatory arthritis, have good energy and mood stability, then a little sugar is not going to end the world. If you are attempting to regain your health and you are recovering from surgery or an athletic injury, then this is a good time to avoid refined sugars completely, or almost.
Personally, I find avoiding gluten easier than avoiding sugar while living an active and social lifestyle. So here is some interesting information that may help you decide your own limits on how much is ok.
There are links to sugar depressing the immune system. In an article from The American Journal of Clinical Nutrition in 1973 showed decreased neutrophil phagocytosis activity with 100 g sugar (included glucose, starch, fructose, and sucrose (from honey and orange juice) intake for upto 5 hours after ingestion, during hours 1-2 with the greatest decrease in neutrophil phagocytosis.3
What does that mean?
A neutrophil is an immune cell that fights invaders, like bacteria and viruses that can make you sick. Phagocytosis is the process when the immune cell destroys the invading bacteria or virus to prevent illness. When sugar is consumed, this activity is significantly slowed, implicating the potential for becoming sick. In the study they used 100g of sugar.
100g sugar = 19.20 tsp sugar
The World Health Organization recommends a normal body mass index adult take in only 25 g/day or 6 tsp. They recommend that the free sugars should be less than 10% of total energy intake and that further reduction to 5% would provide additional health benefits. Unfortunately, this 1973 study didn’t test a lower limit on sugar to see what the lowest dose of sugar needed to produce a depression of the immune cells.
So how much is too much?
The average amount of sugar in some popular yogurt with fruit is about 15g/serving. The average soda contains 40g of sugar. An average granola bar has 12 g of sugar. That’s 67g sugar just on snacks. Its not 100g like the study, but that’s well over the WHO recommendation of 25g/day. And just because it says “sugar-free” or “no high fructose corn syrup”, still check the ingredients and labels. Sugar by another name is still sugar. 100g of “natural” sugar like honey is still sugar to your body.
So when you are looking at your labels, read the grams of sugar and make your decision from there. Listen to your body and how it responds. Give sugar a break for a week or longer, then reintroduce it. How do you feel? How does your body respond?
Personally, when I buy a packaged food, I am sure that 1 serving size has less than 10g of sugar and prefer it closer to 5g. Or better yet, none! I eat those prepackaged things sparingly. Alcoholic beverages often contain a lot of free sugar also, so keep that in mind as you enjoy that glass of wine, beer or mixed beverage. So I save those for special occasions. And if I am fighting a cold or working on healing from an injury, I do avoid those things even more and I increase my consumption of healing foods rich in anti-oxidants and of course bone broth!
But, I drink diet soda, so I am good right?
Although Hu’s study did not show a significant associated risk of RA with diet soda, other studies demonstrate other deleterious effects on health. The journal Nature published an article associating non-caloric artificial sweeteners (NAS) drives glucose intolerance (this is a problem especially in diabetes) by changing the composition of the intestinal microbiota. 4 This is the same microbiome we discussed being beneficial to health and decreasing inflammation associated with RA (see post 4/12/15) . Artificial sweetners include aspartame (aka Nutrasweet or Equal).
If sweetness is something you crave, then try the Lateral Shift technique by eating an apple, berries, or banana. As you adjust to eating whole foods and including healthy fat and protein, you may find the cravings diminish and you may start to notice the sweetness of a carrot!
Remove. Replace. Restore.
Remove refined sugar or at least limit them as much as possible. For sure reduce them to the WHO recommendations of less than 6tsp or 25 g/day. Remove artificial sweeteners. Read the labels on EVERYTHING. Anything that comes in a package likely has added sugar or sweeteners. Anything labeled “diet” usually is code for artificial sweetener. Anything labeled “low-fat” is usually code for “added sugar since taking all the fat out removes all the flavor.” Even “no sugar added” usually means agave or sugar in disguise (beet sugar, etc).
Replace with fresh water, whole vegetables, fruits, and protein (wild and organic preferable). The specific ratios of food and liquid depend on your personal lifestyle, activity level, and health status. For women the Institute of Medicine recommends >9 cups of water/day and for men it is >13 cups/day. Eat the rainbow in whole form and you are doing a lot of good for your musculoskeletal health.
Restore physical health. It is amazing how the body heals. We are only just beginning to understand how. Perfection isn’t the key. Shame and guilt aren’t either. Just keep moving forward and make informed decisions. Stay the course. Our health is a blessing.
Eat Well. Move Well. Sleep Well. Soar On.
1. Hu Y, Costenbader KH, Gao X, et al. Sugar-sweetened soda consumption and risk of developing rheumatoid arthritis in women. Am J Clin Nutr. 2014;100(3):959-967.
2. Guo X, Park Y, Freedman ND, et al. Sweetened beverages, coffee, and tea and depression risk among older US adults. PLoS One. 2014;9(4):e94715.
3. Sanchez A, Reeser JL, et al. Role of sugars in human neutrophilic phagocytosis. J Clin Nutr. 1973 Nov;26(11):1180-4
4. Suez J, Korem T, Zeevi D, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014;514(7521):181-186.
Dr Carolyn Dolan DPT, Cert MDT, MSHN
Where physical therapy, nutrition and lifestyle meet, because how you live your life determines whether or not you soar. Inspiring action with information so you can reduce pain, optimize healing and improve function naturally during recovery from injury, surgery or painful condition. This is a website for the open-minded; obstinate need not apply.