Going Sugar Free for September and Beyond! (Part 1)

Originally posted Sept 2017

To clarify, I am not talking about the sugar that comes naturally in fruits and vegetables and whole grain carbohydrates. I am talking about sugar that is added to cooked foods, processed foods, chocolate bars, ice cream, sodas, and candies.

I started cutting back on sugar two years ago after I had a medical scare and started studying functional medicine. Cutting back meant not eating chocolate bars, ice cream, or candies…the obvious ones. I still had my sweet gluten-free baked goods, and some processed foods. As I became more aware and started reading all the food labels, I realized I am still consuming a lot of added sugar.

Since the Canadian Cancer Society started a Sugar-Free September fundraising campaign, I am going to put in my full effort to cut out added sugar!

While sugar brings certain pleasure in life, the Canadian Cancer Society states: “Most Canadians consume diets high in added sugar, which can lead to excess weight gain. Research shows that being overweight or obese increases the risk of cancer.”  And it’s not just cancer. Sugar is also associated with many other health issues.

What is sugar and what does it do?

Sugar is a carbohydrate made up of two molecules: glucose and fructose. Sugar goes by at least 60 different names: sucrose, coconut sugar, cane sugar, high fructose corn syrup, dextrose, maple syrup, just to name a few.

Sugar is not evil. Our bodies need glucose as energy to function properly, and we’ve been consuming fructose from fruits and vegetables for a long time without ill effects.

Fructose needs to be converted by the liver to glucose or fat. The liver will release the glucose and fat into the blood if needed, or store them as glycogen or fat deposits.

Glucose is absorbed into the body through the gut, or from the body converting carbohydrates ingested. Once in the blood stream, the pancreas detects rising glucose level in the blood and releases insulin.

Insulin is a hormone that regulates how the body uses and stores glucose and fat. Some cells in the body can take glucose from the blood without insulin, but most cells require insulin to be present.

If the body has sufficient energy, insulin signals the muscles and liver to take up glucose and store it as glycogen. Insulin will also turn off fat burning and promote glucose burning as the body’s primary fuel source. Any excess glucose ends up being stored as stored as lipid in fat tissues.

Clearly our body is very smart, and it will do what is required to try and maintain proper balance. But at some point, there may be too much sugar for the body to handle.

Why are we concerned about high sugar intake?

Weight gain and Obesity

As mentioned by the Canadian Cancer Society, it’s not sugar itself that is linked to cancer (although there is one research demonstrating a direct link between fructose and tumour growth); it’s the resulting weight gain and obesity that is linked to cancer.

First, sugar can create an insatiable appetite. Insulin also signals the release of a hormone called leptin, which tells our brains we are full and can stop eating. Imbalanced insulin levels, along with high consumption of sugars, have been linked to leptin resistance. This means the brain no longer responds to the message of stop eating, hence promoting weight gain.1

Fructose has also been singled out as the one with greater impact on satiety. Fructose does not stimulate insulin, which in turn fails to suppress ghrelin, the hunger hormone. This means your body continuously signals you to eat more.  At the same time, continuous secretion of ghrelin further suppresses leptin.

Second, there’s been studies showing that sugar is as addictive as cocaine. One study even showed it to be more addictive. Sugar triggers the brain’s reward centre the same way these drugs do – by causing the brain to release a massive amount of dopamine in an area of the brain called the Nucleus Accumbens1,2. This is why it feels good to eat sugar.

When we eat sugar often and in large amounts, the dopamine receptors start to down-regulate with each dose. This means there are fewer receptors for the dopamine to cause the same response. The next time you eat sugar, the effect is blunted. We will need more sugar to get the same level of reward.

One research paper concluded: “Our findings clearly demonstrate that intense sweetness can surpass cocaine reward, even in drug-sensitized and -addicted individuals”3. No wonder we hear people mention that “I have a craving for [insert your favourite sweet treat]” so often!

How much is too much?

The World Health Organization (WHO) recommends no more than 10% of an adult’s calories, and ideally less than 5%, should come from added sugar or from natural sugars in honey, syrups and fruit juice.4 For a 2,000-calorie diet, 5% would be 25 grams, roughly 6 teaspoonfuls.

On average, in 2004, Canadians consumed 110.0 grams of sugar a day, the equivalent of 26 teaspoons!

Here are a few commonly consumed products and their sugar contents to show how easy it is to surpass the recommendations for added sugar consumption:

Starbucks tall Vanilla Frappuccino with 2% milk, no whip – 46 grams6

Wendy’s small Chocolate Frosty – 46 grams7

Tim Horton’s Whole Grain Blueberry Muffin – 27 grams8

So, are we eating too much sugar? I’d say so.

Ibuprofen or other NSAIDs before vigorous exercise?

A runner posted the following on our group chat:

“My knee was hurting badly, and it’s bothering me even when I am walking now. I still want to run the 50KM ultra marathon in two weeks.  Luckily, a great physiotherapist worked on me and told me that I should be ok. Just take some ibuprofen before the race”.

While many people see nothing wrong with this, I am freaking out as a pharmacist.

NSAIDS, stands for Non-steroidal Anti-Inflammatory Drugs – includes Ibuprofen (Advil), and Naproxen (Aleve). NSAIDS work by blocking certain portions of the inflammatory pathway in the body.  This inevitably creates side effects, as all drugs do. NSAIDs alter renal function, inhibit free water clearance, which may potentially cause over-hydration and hyponatremia (low sodium). And this may lead to cerebral edema especially if you’ve over-hydrated like many of us tend to do.

In a study1 of Ibuprofen use in Ultramarathon athletes (N=29), Ibuprofen did not demonstrate decreased muscle damage or soreness. Rather, it increased endotoxemia and inflammation compared to control group with no Ibuprofen. The ibuprofen group also had increased C-Reactive Protein (marker of inflammation), Cytokines (created to induce inflammation). Ibuprofen also worsened kidney function post race. Another study showed ibuprofen to have negative impact on oxidative stress, which reduces the body’s ability to detoxify and repair damage by the production of free radicals. Free radicals may cause direct damage to cells and disrupt normal energy production within cells, or even cause cell death. This study concluded “Ibuprofen use compared with non-use by athletes competing in a 160-km race was associated with significantly increased oxidative stress.”

As much I want you to crush that 50K run, you need to be aware of these potential consequences of taking Ibuprofen. Please, use with caution.  Just because you can buy it without a prescription, doesn’t mean it’s not harmful. If possible, use a topical anti-inflammatory cream or gel. Diclofenac Gel (Voltaren) is one option. If you want something stronger, you can go to a doctor and get a prescription for Diclofenac 10%, which a compounding pharmacy can make for you.

Oh, another point I forgot to mention: Frequent Ibuprofen use also depletes nutrients, including Calcium, Potassium, Zinc, Iron, B6, C, D and Folic Acid. All these nutrients are essential for your athletic performance. Next time you are tempted to take Ibuprofen before a long run or a hard workout, please think again. Perhaps an additional rest day is the best prescription!

References

1. Nieman, et al. (2006). Ibuprofen use, endotoxemia, inflammation, and plasma cytokines during ultramarathon competition. Brain, Behavior, and Immunity 20.

2. McAnulty, et al. (2007). Ibuprofen use during extreme exercise:  effects on oxidative stress and PGE2. Medicine and Science in Sports and Exercise (39)