Is Sugar Our Problem?


When it comes to our health, we want one thing to blame, which is usually in food form -- and it comes packaged in different names depending on the year or activist(s) in the spotlight.  Back when I first became interested in nutrition in the 1990’s it was dietary fat.  Remember?   Anything that contained fat in your food was going to turn to fat on your thighs!  Unfortunately at that time, I hadn’t taken one biochemistry class to know any different.  So what did I do?  I ate virtually fat-free.  Do you remember those delicious Entenmann’s Danish desserts?  Or, how about the fat-free, organic Healthy Valley oatmeal raisin cookies?  (Hey, they were organic!) Since they contained no fat, I could eat as much as I wanted (sarcasm emphasized).   Unfortunately, people took fat out and that increased both carbohydrates (mostly in the form of sugar to compensate flavor loss) and calories.  As a result, people were not losing fat on their thighs.  Their bodies took the extra energy and packaged it nice and efficiently into adipose tissue (fat) on their bodies.  Lesson here:  take one macronutrient out and it causes an imbalance.  Did we learn that lesson?  I will let you be the judge.


Similiar to the fat-free varities of the 1990's

Oh wait, we didn’t learn.  Since the 1990’s eliminated fat and we got fatter, dietary fat is not the problem.  It’s carbohydrates!  So, Dr. Robert Atkins became an instant star with his very own Diet Revolution.  Out of that became the high-fat, very low carbohydrate diet craze.   

These days, you see all kinds of things implicated in our national obesity epidemic – from sugar or all carbohydrates in general, gluten or grains in general, potatoes or other “white” foods, fructose, processed foods or even restaurant foods.    Carbohydrates of some kind seem to be implicated, although we have gotten more specific in our carbohydrate preference.

I wish I could say that food is always the cure, but it is not.  Food is one part of the issue and one part of the solution.  The causes include a very large mix of physiological, dietary, behavioral, genetic and environmental factors.  Lately, there has been a lot of debate on social media regarding new public dietary recommendations.   I want to share my thoughts on all the clatter. 

Advisory Board Committee’s Report for the Dietary Guidelines of Americans 2015

There is a new set of dietary guidelines coming out this fall and the advisory committee, which is made up of non-governmental scientific experts from across the country, has just published their scientific report.  This report is open to public comments through April 8, 2015.   You can read through it here, but the major highlights on this report that will be considered for the new recommendations includes a liberalization of total fat and lifting of dietary cholesterol limits while having more to say about added sugars and sustainability. Regarding dietary patterns, the committee reports that “current research provides evidence of moderate to strong links between healthy dietary patterns, lower risks of obesity and chronic diseases, particularly cardiovascular disease, hypertension, type 2 diabetes and certain cancers.   They go on to say that “additional strong evidence shows that it is not necessary to eliminate food groups or conform to a single dietary pattern to achieve healthy dietary patterns. Rather, individuals can combine foods in a variety of flexible ways to achieve healthy dietary patterns, and these strategies should be tailored to meet the individual’s health needs, dietary preferences and cultural traditions.”  

Unfortunately, these quotes did not make any headlines.  Why?  It’s so….vague.  What did make headlines was the added sugar restrictions.  People want black and white; they want “yes” or “no” – or what sells is categories of “good foods” (Eat This) and “bad foods” (Not That).  That is just not what the evidence - the total compilation of research - tells us.  Herein lies our dilemma.  We must convince people to look at the big picture when it comes to choosing food and that has been part of my life's work.   Bring any of this up on social media you will find out very quickly how passionate people are on the subject of food and nutrition.  Once a website, book or documentary has evoked a person's emotion (usually through fear), it is difficult to convince someone otherwise.

American Academy of Pediatrics Policy statement on Snacks, Sweetened Beverages, Added Sugars and Schools

The headline on Food Navigator today reads, “Sugar Can Be a ‘Powerful Tool’ to Improve Children’s Diet, AAP.”  As soon as a colleague sent me this for review, I immediately knew it would draw controversy.    As a mom and pediatric practitioner, I had to steady my emotion and click the article to read because the title is quite jarring.  I am sure this article's author wanted to catch our eyes using this title, as there has been a lot of discussion on sugar’s effect on obesity.  It worked!  After I read the article, I then sought out the actual policy statement on the AAP website to read it for myself and discern it with my clinical hat.   They are not advocating a high sugar diet for children.  They are simply clarifying where small amounts of added sugar might have its place in a child’s diet to make foods more palatable.  The rest of the statement revolves around maximizing the overall nutrient quality in the school foods over the approach of a blanket elimination of sugar from school food.  It doesn’t solve all of our children’s nutritional concerns.

The reality is that we do not eat single nutrients, we eat food that has a mix of vitamins, minerals and calories coming from carbohydrates (single and complex), fats (saturated and unsaturated) and protein.  Over the course of a day, week or month we can get a good idea of the quality of a person’s overall diet.  In fact, I do this every day in my job as a dietitian practitioner.  I wish I could tell you that one thing is the thing that causes all our obesity, disease and overall health problems but that is simply not true.  Today it is sugar and tomorrow it will be something else.    Do I dare say that too much of any one thing is the problem?  By the way, I find it ironic that I make this point about sugar because anyone who knows me knows I actually do not prefer sweet foods.  I gravitate toward salty, savory and umami flavors.  So please know that I am not inserting my own bias here.  If I were, it would lean us the other way!

Total Diet Approach to Healthy Eating

As registered dietitian nutritionists, we focus on the foods that should be on your plate.  We know beyond a shadow of a doubt that positive motivation works so much better in every area of our lives when it comes to self-improvement.  Why can’t we get this right when it comes to food?  We need to get off our soap boxes and debates of what it is that is that is causing our health problems and talk about what we know has positive power.    We know that all types of plant-based foods are loaded with a myriad complexity of health powers that cannot be duplicated in a supplement or manufactured product – so focus on fruits, vegetables, beans, legumes, nuts and seeds.  Load your plate with as many varieties and colors.  For those that eat meat, eggs, fish and/or poultry, choose appropriate portions of extra lean cuts (except fish - fatty fish such as salmon and tuna are great choices).  The preponderance of evidence tells us that low-fat dairy contributes a unique nutrient package to our modern day diet, so include those in your meals and snacks.  Whole grains in a variety of forms (not just whole wheat) contribute vital nutrients that maximize longevity, so enjoy them in moderation.  Healthy oils help with flavor and fat-soluble nutrient absorption so focus on olive, canola, flaxseed and other low saturated fat oils when you are cooking.  Enjoy foods such as cakes, cookies and fried foods on occasion (I will choose fried potatoes or buttery anything).  Make more time to eat with family and friends.  Cook at home with your spouse and children whenever possible and make that part of your family’s culture of spending time together.

There are so many positive messages when it comes to food and nutrition – let’s focus on that.  People are hungry for a new and positive approach to feeding their families.  Let’s stop fighting about the one thing that is causing our problems and focus on what we know is best – whole food promotion.  I thoroughly enjoyed Dr. David Katz’s write-up today on LinkedIn entitled, “We’re Fat and Sick and the Broccoli Did It!”  Although it is long, it is worth the read.

The Academy of Nutrition and Dietetics has a position paper called, “The Total Diet Approach to Healthy Eating.” This position states that “that the total diet or overall pattern of food eaten is the most important focus of healthy eating. All foods can fit within this pattern if consumed in moderation with appropriate portion size and combined with physical activity. The Academy strives to communicate healthy eating messages that emphasize a balance of food and beverages within energy needs, rather than any one food or meal. “  In this position paper, it goes through in detail how someone can eat the foods they enjoy – even if they might be high in sugar or fat – and still be healthy as long as the frequency and quantity is appropriate. 

While it is very sexy to say that there is one thing in our food supply that is causing all our health woes, the fact is that it is simply not true.  Do not believe the hype.  Make small, consistent changes and focus on increasing whole foods.   It is simple, but tried and true throughout the years.

March is National Nutrition Month

What a perfect time to go on my total diet approach rant.  Throughout the month of March, we will be blogging positively on the power of whole foods.  Why?  March is National Nutrition Month, and although we believe every month should focus on nutrition, March is an opportunity to really saturate regular and social media with positive, “news-you-can use” food and nutrition tips.  This month’s theme is Bite Into a Healthy Lifestyle.   Healthy living involves enjoying our foods, and we will emphasize foods that are good for our health, our palettes and for our busy schedules.  So join us in promoting the total diet approach to healthy living!  Since sustainability is an emphasis these days, think about it in terms of health approach altogether.

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