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Cane sugar. Honey. Fruit juice. Are all forms of sugar created equal? And how much of the sweet stuff is too much? Maxine Smith, RD, LD, reveals how to uncover hidden sugar in our diets, cut down on cravings and create healthier eating habits.

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Real Strategies for Eating Less Sugar with Dietitian Maxine Smith

Podcast Transcript

Deanna Pogorelc:  Welcome to the Health Essentials podcast brought to you by Cleveland Clinic. I'm your host Deanna Pogorelc. It's estimated that the average American consumes about 17 teaspoons of added sugar each day from sweetened beverages, desserts, and other mostly processed foods. All of that sugar can affect not just our waistlines, but our entire bodies and our long-term health. Here to help us get smarter about sugar is Maxine Smith. She's a registered dietician in Cleveland Clinic's Digestive Disease and Surgery Institute. Welcome, Maxine. Thanks so much for being here.

Maxine Smith:  Thanks for having me, Deanna.

Deanna Pogorelc:  For our viewers and listeners, please remember that this is for informational purposes only and is not intended to replace your own health care provider's advice. So Maxine, when we eat something that has a lot of sugar in it, like if I grab a doughnut for breakfast, could you walk us through what happens in our body immediately after we eat something that's high in sugar?

Maxine Smith:  Yes, absolutely. So when you have a food that's high in sugar, like a donut, you will digest that donut and even if it's made of carbohydrates, for example, white flour goes into the donut. It's broken down into sugar in the gastrointestinal tract and then absorbed into our blood as sugar. That sugar will either go to our cells, such as muscles, or our brain cells to be used for energy, or that sugar will go to the liver to be converted into fat. That's all dependent on the hormone insulin, which is produced in our pancreas.

Deanna Pogorelc:  Okay. So then if I keep eating donuts for breakfast every day over time, what are some of the things that can happen to the body?

Maxine Smith:  Well, one thing is that the sugar is replacing other healthy nutrients. So you're displacing many nutrients that you need for health. The other thing is that sugar is empty calories and they can easily, as I mentioned, be stored as fat. So this can lead to obesity. Sugar, particularly likes to be stored around the belly area, which is arguably the most toxic part of fat in the body, which can lead to diseases such as diabetes, heart disease and stroke, high blood pressure and so forth. We can also get conditioned to desiring that. It can be very much of a habit as we all know, and that's something that we don't want to develop.

Deanna Pogorelc:  Is there any benefit to sugar? Do our bodies need it for any reason to survive?

Maxine Smith:  Yeah, absolutely. A body needs three macro nutrients. We need protein in our diet, we need fats in our diet and we need carbohydrate in our diet. Sugars link together our carbohydrates. Our body needs those ... particularly our brain uses solely carbohydrate as energy. Yes, they can use some other things in particular situations, but primarily carbohydrate is a source of energy for the brain.

Deanna Pogorelc:  Okay. Then are there other sources of carbohydrates that would be preferable to something that's high in sugar?

Maxine Smith:  Yes, absolutely. So the more complex the carbohydrate or the less processed the carbohydrate, the healthier the carbohydrate food. It's handled very differently by the body. It has fibers, for example, that slow down the breakdown of that carbohydrate into those sugar [inaudible 00:04:50]. Those fibrous foods also have many other nutrients that give a health benefit. The fibers also help fill us up and the weight of many whole foods such as a apple gives us also a sense of fullness, whereas quick sugar may not do the same for us and can lead to more of a crash.

Deanna Pogorelc:  Is all sugar created equally? Is something that's sweetened with a natural sweetener like honey or maple syrup, is that preferable to something that's made with cane sugar you buy in the grocery store? What's the difference between these different kinds of sugars?

Maxine Smith:  When it comes down to metabolism, sugar is sugar. There are slight differences in mineral content. For example, honey, maple syrup, some of the dark brown sugars and molasses and so forth. They may have small amounts of minerals that you don't see in refined sugar or white sugar products. However, really in the scope of getting those nutrients in your diet, that's going to be a very minimal source. When it comes down to it, again, basically one sugar is going to act just like any other sugar when it comes to triggering that insulin response, raising blood sugars and fat storage.

Deanna Pogorelc:  What about fruit? So we know that some fruit can be high in sugar. Where does that fit in to this conversation?

Maxine Smith:  Fruit got a bad rap for a long time, and I'll still have patients that will eat a granola bar, but they're afraid to eat fruit. So fruit is, like I mentioned before, it's a complex carbohydrate and the fibers and the fruit slow down that sugar absorption. It's very rich in nutrients, loaded with different plant chemicals that we can only get through produce, thousands of different plant chemicals goals that work synergistically together to provide us help and meet the needs of our body. Also, fruit is a great replacement for some of the sugary foods. It satisfies those taste buds while being a slower released carbohydrate to provide more sustaining energy.

Deanna Pogorelc:  Is there a recommended or acceptable limit on how much sugar we should be eating a day?

Maxine Smith:  There's a couple of different guidelines. The American Heart Association, for example, recommends no more than six teaspoons of sugar a day for a female and nine teaspoons of sugar a day for a male. That equates to 24 and 36 grams of sugar a day. It's not very much. For example, I did some playing with numbers. 24 grams is about the amount of sugar that you would get in a half cup of a dessert. So those little old fashioned, little ice cream containers with the wooden spoon. That contains about 24 grams of sugar, but it does not only hide out sweets. I was waiting for a friend at a restaurant other day and of course being the nutrition nerd I am, what do I do? I pull up the nutrition facts for the restaurant. Guess what also had about 24 grams of sugar? The side serving of coleslaw. Add to that the half of barbecue chicken that had the 36 grams, you have the male and female amount for one day in that one meal.

Deanna Pogorelc:  Wow. Yeah. So where are some other places that sugar might be hiding that we might not be thinking about necessarily?

Maxine Smith:  It hides out in a lot of different places. So you really need to be a sugar detective. It hides out in many sauces. It's estimated that 80% of grocery store foods have added sugars. I challenged myself once to not eat anything with added sugar, and literally I wound up shopping around the periphery of the grocery store, maybe going down the frozen vegetable and fruit aisle. Sauces, ketchup, soups, breads have added sugar. I was surprised the other day, I had a spring roll and the chili sauce that came with it had the equivalent of six teaspoons of sugar in a little packet of sauce. Peanut butters. Many, many different foods have added sugar.

Deanna Pogorelc:  Yeah. If we're looking at processed foods like a granola bar or something, are there other words that might be used in place of just plain sugar or honey or maple syrup? Or how can it be disguised on a nutrition label?

Maxine Smith:  It surely is disguised. It can hide out under names that sound relatively healthy. Brown sugar, natural sugar, honey, agave syrup. Like I mentioned, molasses, fructose. Anything with a "ose" at the end of it, it's most likely going to be a sugar. It can be even though not listed on a nutrition facts label as added sugars, it could be concentrated fruit juice. Really, if the natural sugar in juice is so concentrated, it's acting like sugar in the body.

Deanna Pogorelc:  Okay. So when we're looking at that nutrition label, is it important to pay attention to total sugar or now it has that added sugar line on it? What's the difference, and how do we navigate that?

Maxine Smith:  That can confusing. The added sugars are those that are not naturally found in foods. You do have natural sugars that are found in dairy products. Lactose, baby cows need some sugar. So you're going to find natural sugars in dairy products. You're going to find natural sugars in fruits. The added sugars are going to be the things that we mentioned that you need to be somewhat of a sugar detective. You can also identify added sugars by looking down at the ingredients and looking for some of those sugar words. It is more important to take into consideration those added sugars. As I mentioned, the natural sources are going to be more complex and have other compounds that slow down that influence of sugar in the body.

Deanna Pogorelc:  Okay. So for someone who wants to cut back on their sugar intake, should we be tracking and counting our sugar or what should the approach be there?

Maxine Smith:  That could be a great first step, particularly if you're not aware of the various foods that are rich in sugar. There's different ways that one can do that. One could use an app to help identify the added sugars in the foods. Another option would be using ... one of my favorite tools is the food UK app like educate, but Fooducate. This identifies the quality of a food item in a particular category. So say you had a cereal, you could scan the barcode, it would rate that. One of the criteria for their ratings is the added sugars in that food. Then they would go on to make suggestions for foods that have less added sugars. But awareness absolutely is the key because many, many people just are not aware of the added sugars. I'm perplexed sometimes myself by foods that may come out, new foods, and the amounts of added sugars in those foods.

Deanna Pogorelc:  So if someone is thinking, "Okay, maybe I'll swap my soda for a diet soda," or taking candy that's sugar-free instead of just regular candy, are these products any better for us?

Maxine Smith:  Well, they can be used as a bridge to get off regular sugar, to reduce regular sugar in the diet. In some conditions, it may serve that short term purpose. However, most major medical associations at this point, the American Dietetic Association is recommending steering off those artificial sweeteners all together and just trying to work on taming those taste buds towards a lower sugar intake overall.

Deanna Pogorelc:  Okay. Can we talk a little bit about cravings? Because I know that's a challenge in terms of cutting back sugar. What are some of the reasons that we crave sugar? Is it true that having sugar early in the day can make you continue to crave it throughout the day?

Maxine Smith:  Yes, that is one of the most deleterious effects of sugar, is that it sets us up for cravings. We all know that anybody that hasn't gotten a good night's sleep or maybe is under a stressful situation, which many of us have been lately, those sugar cravings kick in and they seem to sometimes take control over our logic.

Yes, sugar. First of all, it's quick energy, right? Carbohydrates are the energy nutrient and sugar is very broken down. It's very quickly absorbed into the blood, especially in liquid form. So what do we do when we need energy? We go to the local coffee shop and we don't just get the plain coffee. We get the one with all the syrup and the whipped cream. So not only do we have the caffeine boost for energy, we also have sugar boost. Unfortunately, we know later what's going to happen, right? That crash. It's going to set us up for another one.

The other reason is it stimulates different neurotransmitters in the brain, a major one being dopamine, which is the pleasure neurotransmitter. So it gives us, we all know, a sense of pleasure. That's one reason that I feel parents often provide those sweets for their kids. They feel that that's something that's part of childhood, a pleasurable part of childhood. It also triggers other neuro-transmitters that can give us a sense of calm if we're under stressful situations. Unfortunately, when that blood sugar goes up and it serves its purpose and then it crashes, it sets us up to desire more sweets to get us back where we were. It can be a somewhat of a vicious cycle.

Deanna Pogorelc:  So what advice do you give to patients who maybe are experiencing that or trying to cut back their sugar or struggling? What are some of the steps that people can take?

Maxine Smith:  Well, as you mentioned, just becoming aware is very important. So slowly writing down what you eat, anything that isn't a whole food and by whole foods I mean a single ingredient food. So if it's not a peanut versus peanut butter, you have to be suspect of that. It may have sugar. So doing some investigative work, investigating how much sugar source is in those foods. Then you are educated, you can at least make an educated decision. Also, having a meal plan in place. So every day, going into that day with a plan, thinking about how are these foods I'm choosing and planning going to nourish my body and serve me to do the things that I really enjoy in life and energize me and keep my brain sharp and all of those important things?

So going into it with a plan. We often start out strong in the day and then comes that two o'clock where our willpower has petered out and that more primitive part of our brain takes over and those impulses to grab that candy bar just seem over powering. So at least if we have a plan in place, interject a healthy snack at about that 2:00 PM crash. Maybe some fruit nuts to give you a little bit of energy boost, but in a healthy manner. We're less likely to get off track, even if you don't follow your plan perfectly.

Also, it's so important to look at the underlying issues. So many people never get down to those underlying issues so they're always putting band aids on a wound. Getting enough sleep, very, very, very important. Inadequate sleep triggers hormones such as ghrelin and cortisol that make us hungry, make us crave carbohydrates, make us have sugar cravings. It somewhat makes sense. When you're tired, your body's saying, "Give me quick energy." So optimizing your sleep and doing whatever you need to prioritize that. Also, stress management. Since that's another reason that we gravitate almost impulsively towards sweets when we're stressed, it's so important to practice healthy stress management techniques. Also, practice self-care. Another reason we gravitate toward sugar is we want that reward, right? We did something good. It's a natural thing. When you're a kid, maybe you'd get a sweet. Our brain does sense sweets as being rewarding, so finding other ways to love ourselves, to do nice things for ourselves. Interject those into your day, plan those into your day.

Maybe after dinner, when you're tempted to snack on sweets, plan something that's relaxing and rewarding. Even if it's a 10, 15 minute activity, that can make a big difference. Other things, exercise is very important. Research has shown it decreases ... when they do brain scans, they show someone a picture of a Twinkie, their brain lights up less when they exercise. So it's not as exciting for the brain to go towards those things. So very important to have a healthy exercise routine, which also decreases stress.

Deanna Pogorelc:  So you did mention meal planning and I wanted to ask how can we plan good, healthy meals that satisfy us and also support our goals?

Maxine Smith:  When you're thinking about meal planning, first of all, the timing of the meals is important. One reason that people gravitate toward sugar is because they're going long periods between meals and they need that quick energy.

So planning meals or a healthy snack about every four to five hours apart, don't go too long. At meals, you want to consider what are going to be the nutritious foods. There are several models that can give us guidance in that area, such as the Mediterranean type of eating pattern, the DASH eating pattern, all these meal patterns are rich in whole foods and produce. They do include lean protein sources and healthy fats. Fat once got a bad rap, but actually healthy plant based fats like olive oil, avocado, nuts, they slow down the sugar absorption from carbohydrate foods into our blood. So keep those peaks or rolling hills and spikes. The protein also provides a lot of different amino acids like L-tyrosine that has an effect on the brain to increase some of those positive neural transmitters like serotonin that give us a sense of peace and decreased anxiety.

So the protein and healthy fats are very important to incorporate with our meals, as well as those complex carbohydrates that are going to provide us energy over a longer sustained period of time. But it's not only important to focus on the what you ate in the when you ate, but the why and the how one eats is a area that is vitally important, but many people never venture into that area. You can train yourself to get great satisfaction, sensory satisfaction, and contentment from a much smaller amount of, say, a sweet after dinner, a dark piece of chocolate or a couple bites of a dessert shared amongst a group, if you pay attention.

So focusing on that food, trying to eliminate any distractions, put down the phone, turn off the TV, eat in one place at the table and pay attention to all the sensory qualities of that food. The smell, the taste, the texture, and eat slowly and savor it. Keep it in your mouth a longer period of time. It's amazing at how gratifying a food can be if you eat it in that manner. Also consider the why. Why am I eating this? Am I truly hungry? Or is it because I'm anxious because I have that test tomorrow or that crazy child I have to get to bed and he's running around the house? So what is driving my hunger? Is it head hunger? Is it stomach hunger? Exploring some of those things is very, very important to getting to the root of cravings and overeating sugar.

Deanna Pogorelc:  Absolutely. So once we start making some of those changes, maybe it might feel really hard at first, but will it get easier once we start to kind of interrupt that sugar cycle?

Maxine Smith:  It absolutely does. For some people, it might take a little bit longer than others. It could take anywhere from one week to one month to several months. The important thing is to support the change. Get support from others, work as a family to decide on what kind of foods you're going to bring into the home. Because if they're there, you are going to be tempted by it. Talk to other people at work and maybe come to some kind of agreement about what types of foods that you're going to have around the workplace. So providing support can make the whole process go a lot smoother and easier. Meet with your dietician. If you feel like you have a very strong compulsion towards sweets and cravings, it could be some other issues. Medications can cause some of those cravings. There could be some deeper psychological issues, which need to be addressed and uncovered. So there are a lot of different factors to determine how quickly that process will take, but there's definitely hope.

Deanna Pogorelc:  Great. What are some of the benefits that we can expect to see once we start curbing our sugar intake?

Maxine Smith:  Well, at first, to be honest, you may feel a little bit more tired, maybe a little bit more cranky. So you have to warn your family members and your friends about that. But again, getting enough asleep, getting some exercise, going for a walk, those things are going to be very important. So you may feel a little bit blunt at energy level, a little bit of anxiety even, because you're accustomed to that sugar. Over time, even though you might not have that peak in energy, you're going to have a more sustained energy level throughout the day. More focus, the craving subsides, you don't feel as compelled to eat. You're not so much a captive of that chocolate bar that's sitting in front of you. Many people, clear focus, increased energy, increased stamina, and many other things. Improved complexion and so forth.

Deanna Pogorelc:  Great. Well, Maxine, this has been fantastic. Is there anything we didn't touch on that you would like to leave our viewers and our listeners with?

Maxine Smith:  I would just encourage people to not try to change everything at once. Too many people throw in the towel because they aim for perfection. You want to aim for continual progress over time. It's taken me many, many years to transform from a very unhealthy childhood diet, and I'm still working at it. Set small realistic goals, and be kind to yourself. You will make mistakes, you will stray from your plan. You need to expect that. So just don't beat yourself up over that. Don't be judgmental, but just step back like an outsider and take a look at, "Okay, what led to this blip? What can I do different next time? How I can get support from others?"

Because we need to join together with community to fight the battle against all these very, very alluring processed foods that can lead to high sugar intakes and these cravings.

Deanna Pogorelc:  Well, thank you so much for being here, and if you'd like to schedule an appointment with a Cleveland Clinic registered dietician, please call (216) 444-3046. To listen to more podcasts with our Cleveland Clinic experts, visit clevelandclinic.org/he podcast, or subscribe wherever you get your podcasts. For more health tips, news, and information, follow us at Cleveland Clinic on Facebook, Twitter, and Instagram. Thanks for tuning in.

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