Dear DOCTOR Owen:

I have read about the “hype” of sugar and how it is the cause of all of our health evils. I saw a diet specialist rip apart the Sugar Busters!TM diet author (book by H. Leighton Steward et al.) on national TV a few months ago for making claims without any research to support them. And Dr. Atkins has been “bashed” for years. What’s your opinion about whether sugar is bad—fact or fiction?

Sweetie Pie

Dear “Sweetie”:

I hate adjectives such as “good,” “bad,” “ugly”! I like to refer to food as “high fat,” “low fat;” “low calorie,” “high calorie,” “worth it,” “not worth it.” “Bad” implies that food has character; therefore, you are bad if you eat such and such food. I see and hear this all day long, and it makes me “nuts”!! Food either contributes to weight gain and disease—or not.

Now, as to your question: Is sugar good or bad? Data exist that support the idea that simple sugar (refined sugar) causes more weight gain, disordered eating, and disease than complex sugars (carbohydrates). Both the Atkins and Sugar Busters!TM diets propose that a sudden high rise in blood sugar, which occurs with simple sugars, causes an equally high response of insulin, the hormone that regulates sugar. This elevation, in and of itself, causes many problems and diseases such as diabetes, high blood pressure, and high cholesterol. I believe that their premise and the data are accurate in this regard.

A very powerful report in the Townsend Letter, Vol. 187, 80–86, linked a dietary sugar (fructose) to ischemic heart disease (from cholesterol), primarily due to the excess production of triglycerides that simple sugar caused through the over-production of insulin. This statistical article looked at data since the 1950s.

Unlike simple sugar (sucrose), fructose, consumed directly, or derived from sucrose (table sugar), is metabolized to triglycerides—the “other” blood fat with cholesterol. Therefore, fructose consumption leads to large increases in triglycerides in the serum. The triglycerides are incorporated into a type of cholesterol called very low density lipoprotein (VLDL), which contributes to cholesterol deposits in the arteries. The evidence suggests that fructose is the main dietary link in pre-menopausal women, whose hormonal patterns favor the metabolism of fructose to VLDL. This is seen especially in women with high diabetic risk in their families. Lactose, in milk, in particular had a very strong correlation. Finland has the highest heart attack rate in the world and the highest dairy consumption.

This challenges the concept that saturated fats are at the root of all atherosclerosis in the arteries. It supports data suggesting that Dr. Atkins’ high protein, high fat diet may not be as harmful as expected (the same with Sugar Busters!TM). The Townsend Letter article made a strong claim for using artificial sweeteners and avoiding dairy products—a valid claim, as cholesterol kills about 70% of everyone over the age of 40.

The high insulin levels created by sugar also cause behavioral changes. Insulin causes cravings; increases baseline hunger scores; and creates fatigue and lack of motivation, or “laziness.”

Thus, the claims made by these authors may yet be proven by good critical scientific analysis. When combined with fat-blocking medication like Xenical® (Orlistat), the principles of what these authors say may have a place in a diet plan.

We diet and health counselors must take every new piece of research and apply our scientific knowledge to your individual case. You are unique, and may not be like the next person. For example, your ability to handle insulin may be different and changes with age. You have your own special tastes, preferences, and cultural attitudes (“let the good times roll”). Therefore, “the” be-all and end-all diet will never exist.

A diet, which I define as a conscious method of eating, will be successful if you are conscious of what you are eating and apply a realistic method of caloric intake. Substituting artificial sweeteners, for example, for simple sugars will satisfy sweet-tooth cravings. Decreasing your carbohydrate intake will unquestionably help you with your weight management.