Death By Cupcake

Happy Valentine’s Day! People who know me will say today’s health tip on the dangers of sugar is just typical, badgering innocent people on a holiday dedicated to love, romance, and dessert. Before we get started, let me pull out my two favorite passive-aggressive chestnuts: “I’m just looking out for your best interests” and “I only want to help.”

If instead of cupcakes or a five-pound box of chocolates you bought your dearest a bouquet of fresh flowers or a sparkling diamond bracelet, you’ll be more relaxed about reading this, possibly feeling a tiny bit smug and self-righteous.

For the rest of you: according to an article in last week’s journal Nature, you are poisoning your sweetheart.

Maybe you’ve already heard about this. Three researchers from different fields (a pediatric endocrinologist, a sociologist, and an expert in public health policy) are recommending that sugar be regulated like alcohol and tobacco. This means all sugars, and if you click through you’ll see the list of other names for sugar includes the much-marketed agave nectar as well as fruit juice concentrates, dextrose, honey, syrup, and on and on.

In fact an increasing number of illnesses are being linked to sugar. If we add up all sugar-related deaths, the number comes to a whopping 35 million deaths worldwide every year. This grim statistic occurs as a result of three sugar-triggered conditions that are developing at a record pace: metabolic syndrome (and its consequences–diabetes, high blood pressure, and heart disease), non-alcoholic fatty liver disease, and, less commonly, non-alcoholic steatohepatitis.

The US and its astonishing sweet tooth

An analysis of grocery records determined that back during the pioneer days, when sugar was a luxury, we ate about 15 pounds of it per year. But currently each and every American is downing 150 pounds annually, much of it tucked surreptitiously into processed and prepared foods including low-fat and zero trans fats foods. The 150-pounds-per-year figure, by the way, translates to a daily intake of just a bit more than 0.4 pounds of sugar, or 45 teaspoonfuls (dangerously close to one cup) every single day. Considering a can of soda alone contains 13 teaspoons of sugar, you can get to 45 pretty quickly.

The reason for the new alarm about sugar is not simply that it’s an “empty calorie,” completely devoid of nutritional merit, but that sugar is handled by your body in much the same way alcohol is (which makes sense since, if you remember, alcohol comes from sugar).

Both high fructose corn syrup and sucrose (table sugar) are equally destructive. Here’s what happens when you ingest them: after being absorbed through your intestines, the sugar passes through your liver. When your liver is overwhelmed by sugar, it converts sugar to fat molecules, which are then stored in liver cells themselves. This condition, called fatty liver, was once a relatively rare condition, generally seen in alcoholics prior to developing cirrhosis.

But now, so many non-drinkers and moderate drinkers are being diagnosed with fatty liver disease that most cases are called non-alcoholic fatty liver disease (NAFLD). Once considered a generally harmless condition, we now know that people with NAFLD are at increased risk for metabolic syndrome (more on this later) and the especially severe form of fatty liver called non-alcoholic steatohepatitis (NASH), which can lead to cirrhosis or liver cancer.

Over the past 20 years, the frequency of fatty liver has escalated, directly correlated to our escalating sugar consumption. A fatty liver triggers a change in liver metabolism, not only storing fat but producing more bad cholesterol (LDL) and less of the helpful form (HDL). Your fatty liver is a source of increased inflammation as well, inflammation that causes LDL cholesterol to deposit itself inside your arteries, a significant cause of both heart disease and high blood pressure.

Metabolic syndrome

The most common and dangerous consequence of excess sugar intake is not fatty liver, but rather metabolic syndrome (though most people with this condition have some degree of fatty liver as well). Faced with a daily onslaught of 45 teaspoonfuls of sugar, your pancreas–desperate to lower your blood sugar–pumps out insulin, a hormone that lowers blood sugar levels by driving sugar into cells, where it’s used for energy.

Ultimately this whole system of pancreas, insulin production, and sugar transport becomes fatigued. Your insulin production drops, your cells become increasingly resistant to insulin, your blood sugar begins to rise, and you develop diabetes. And all that excess insulin in your blood triggers the release of a brain chemical called leptin. At normal levels leptin is helpful, telling your brain that you’re no longer hungry so that you’ll stop eating.

But too much leptin is not useful because it causes the leptin molecule to stop working. You can’t tell when your hunger is appeased, so you keep eating and you get fatter. Too much leptin also increases inflammation, and you know where that leads.

I’m now seeing more patients with metabolic syndrome than ever before in my three decades of medical practice. It’s a significant concern because patients who develop metabolic syndrome have a very substantial risk of progressing to diabetes and heart disease.

By our current definition, metabolic syndrome is a combination of the following:

• Abdominal obesity (for men greater than 40 inches, for women greater than 35 inches).
• Elevated blood triglycerides (a blood fat).
• Low HDL (the good cholesterol).
• High blood pressure.
• Elevated fasting blood sugar or abnormal glucose tolerance test.

You can reverse all of this yourself

If there’s a positive spin on the metabolic syndrome, NAFLD, and NASH, it’s they’re all reversible by healthful eating and regular exercise. A solid first step is to drastically cut back on sugar, but you’ve got to approach good health, changing your eating habits, and the care of your body with the same gung-ho enthusiasm of a born-again finding Jesus.

Work with one of our nutritionists (Marla Feingold or Seanna Tully) to understand how real foods can help you get well. Then start cooking for yourself.

At the same time, activate your expired health club membership, quit using your treadmill as a clothes hanger, or hire a personal fitness trainer.

Of course it’s a good idea to prevent this from happening in the first place. Which brings me full-circle back to Valentine’s Day and cupcakes/chocolates on the front seat of your car.

If you consider that metabolic syndrome, NAFLD, and NASH are our “new diseases,” that obesity levels are highest in recorded history, and that all this began with our unstoppable craving for sugar, you can appreciate why the researchers writing in Nature place sugar right up there with alcohol and tobacco, needing someone to step in and say “stop!

Be well,

David Edelberg, MD