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Let’s Talk About Sugar

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by: Le’Vena Tan, Nutrition Masters Student & Guest Post Writer

From sugar taxes, listing added sugar on nutrition labels, to words like ‘’toxic”, ”poison”, ”evil” constantly being used to describe sugar, sugar gets a lot of bad press from public health professionals and the media as being the food to avoid. Recently, I saw a social media post about dietitians being advocates for carbohydrates/sugar, because of misconception and fear surrounding sugar propagated by diet culture.

What is sugar and why is it important?

Sugars are broken down forms of carbohydrates. They supply our body with energy necessary to perform our day-to-day activities, resting, eating, thinking, moving etc. Sugar is a great quick source of energy to help restore our blood sugar, especially when it is low. An added bonus, sugar tastes good! There are three different types of sugars: simple sugars (monosaccharides), disaccharides (containing 2 sugar molecules) and complex sugars (polysaccharides). 

The science behind sugar metabolism

Add sugar, lemon zest and lemon juice to berries

Glucose

Glucose is the simplest form of carbohydrate and the preferred form of energy for most cells in our body, especially the brain. After being absorbed into the body via the intestinal lining, glucose is broken down by the cells in our body to provide energy for essential metabolic processes and our daily activities. In excess, glucose is stored as glycogen, the storage form of glucose, or as fat in our body. 

Fructose and Sucrose

Fructose and sucrose are found naturally in fruits, vegetables, and nuts. Fun fact: table/granulated sugar are examples of sucrose, manufactured from sugar beets or sugar cane. Fructose is a simple sugar just like glucose with a different chemical structure. Sucrose consists of equal parts glucose and fructose. The body has to break down sucrose into glucose and fructose molecules in order to use it for energy. It’s important to note that most sugars are typically consumed with fiber, vitamins, minerals, antioxidants and phytochemicals, which helps our body fight against diseases. 

High Fructose Corn Syrup

High Fructose Corn Syrup (HFCS) is typically found in packaged foods and beverages. It is commonly 55% fructose and 45% glucose in beverages and 42% fructose and 58% glucose in baked goods and other foods. Similar to sucrose, HFCS needs to be broken down into its glucose and fructose molecules. 

Our body processes sugar the same way, regardless of its source (naturally occurring or from manufactured, processed foods). But, there are some differences in the metabolic pathways glucose and fructose undergo in our body, even though the end-product of both are basically the same.

How do our bodies break down fructose?
  • First, fructose is mainly broken down in the liver.
  • Second, fructose has to undergo additional steps before entering the same metabolic pathway as glucose to provide energy to the body.
  • Third, unlike glucose, fructose doesn’t trigger insulin secretion, whose role is to regulate our blood sugar and hunger and fullness cues. Fructose intake can affect our hunger and fullness cues by increasing our desire and appetite for food and decreasing the satiety signal of our brain 1,2. 

A word of caution:

it is helpful to know the science behind how sugars are metabolised in our body. But, it is even more important to note that we do not consume sugar in isolation and our diets typically consist of a variety of foods. The mechanisms of how food is broken down in our body is highly complex and hinges on many factors. For example, eating an apple with peanut butter (adding protein and fat), our body processes the fruit sugar differently than eating an apple alone. More reasons to not agonize over our sugar consumption.

Favorite Everyday Salad

What does this all mean? 

I think this means that we shouldn’t go around labeling some sugars as good or bad. It doesn’t serve us to make rules about which sugars are better to avoid or worry about how much glucose or fructose we are taking in, or avoid sugar all together. These actions have the effect of making sugar all the more desirable, which contradicts the initial motivation in the first place. Black and white rules make us feel guilt and shame about our eating, which doesn’t lead to increased health and well being. 

Instead of Using Rules

If sugar isn’t all bad, then how can we think about sugar? 

Remember that everybody’s biology, genetic make-up and history with food is different, so you can have very different reactions to different types of sugar to your friends or family.

Instead of thinking about food in a dichotomous, (good or bad) way, you can decide how sugar fits into your food intake. Trust your body. It has a lot of wisdom – and internal information is just as important as the external information we get from science, if not more so. Explore how your body and mind feel when you eat different sugar-containing foods.

Ask yourself:

  • How does this (sugar-containing) food taste on my tongue? 
  • Does it taste good? Or is it just the idea of it that tastes good? 
  • How do I feel (physically and emotionally) immediately or a few hours after consuming it? 
  • Do I feel differently if I eat it with other foods? 
  • Am I hungry to eat this or do I want it because I usually don’t allow myself to eat it? 

Giving yourself the opportunity to explore how you feel after eating sugars, helps you understand your response to them and, maybe, get more satisfaction out of your eating experience. Being curious, rather than using rules, helps us eliminate the guilt and shame that can come from black and white rules. Tuning in, may help you identify the sugar-containing foods that you love and maybe others that you don’t really enjoy at all. 

Le’Vena Tan is a graduate student in the Department of Nutrition at University of North Carolina at Chapel Hill. She is also a lactation student in the Mary Rose Tully Training Initiative (MRT-TI) under the Carolina Global Breastfeeding Institute. Her interests include pediatric and maternal nutrition, breastfeeding, responsive feeding, intuitive eating, Health at Every Size® and public health, especially food insecurity. She hopes to practice from a weight-inclusive lens and to utilize her knowledge in public health to help better the community. She enjoys engaging in creative pursuits and would like to incorporate some creativity in her work in the future. Le’Vena can be contacted via email at levena.unc@gmail.com.

Citations:

  1. Lowette, K., Roosen, L., Tack, J., & Vanden Berghe, P. (2015). Effects of high-fructose diets on central appetite signaling and cognitive function. Frontiers in nutrition, 2, 5. 
  2. Luo, S., Monterosso, J. R., Sarpelleh, K., & Page, K. A. (2015). Differential effects of fructose versus glucose on brain and appetitive responses to food cues and decisions for food rewards. Proceedings of the National Academy of Sciences, 112(20), 6509-6514.

A School Nutrition Lesson: The Edible Parts of a Plant

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Update: Brain Pop removed the quiz question mentioned in this post after we contacted them and expressed our concern. They also agreed to change a troubling lesson on sugar that contained weight bias.

Over the last 2 months of the COVID-19 stay at home orders, like many of you, I have been home more with my children and helping them with their virtual learning. I have a 7th grader and a 4th grader, who both over the last several weeks have had school lessons about nutrition and health.  Over the years, I’ve had some exposure to their nutrition lessons, but I’ve had a much closer look these last couple of months. It’s highlighted for me how much work we have to do regarding how we teach our children nutrition.

Over the last 20 years, how and what we teach children about food has become more weight focused and developmentally inappropriate.  Instead of teaching children where food comes, exposing them to new foods, and teaching them to care for and respect their bodies, we teach fear and mistrust. The examples of this are endless, but a few were literally in my home recently.

We need to stop teaching children that appearance indicates health.

A couple weeks ago, my 7th grader was learning about hypertension and took a quiz on “Brain Pop,” a teaching platform commonly used in US schools.  She called me into her room to view the question, because she knew how offensive it was. The question read: “Which of the following people are least likely to have hypertension.” There were then 4 cartoon images:

  • A. A woman of color, with yellow teeth, smoking a cigarette
  • B. A man in a large body
  • C. A thin man, with gray hair
  • D. A man in a baseball hat, with a baseball bat
This is a screen shot of the quiz question from the Brain Pop website. I debated including it, because it is so offensive. I have decided to include it so people can see that this is not being exaggerated and how important it is that we change how we teach children about nutrition and health.

The quiz question was upsetting on so many levels and reinforces stereotypes and stigma. My daughter immediately pointed out to me how terrible it was to portray a person of color in this way, and the stereotypes it was perpetuating. Furthermore, the question asks the student to make a judgement, based on a cartoon picture, and then equate it to a health marker you cannot see. We are literally teaching children to judge people by how they look. 

A 2008 study, looked at if BMI was an accurate indicator of metabolic health. In the study, the researchers defined metabolic health by blood pressure, cholesterol, insulin resistance, and inflammation​ indicators. The study found that using BMI as an indicator of metabolic health, misdiagnosed 23.5% of “normal” weight people as healthy​, misdiagnosed 51.3% of “overweight” people as unhealthy and misdiagnosed 31.7% of “obese” people as unhealthy (doi: 10.1001/archinte.168.15.1617). If we know this, why are we teaching children to judge someone’s health by looking at a cartoon portrayal of a human? What we know is that health doesn’t look a certain way and stigma and prejudice of all kinds leads to worse health outcomes.

We need to stop teaching children to fear foods.

During the same unit, my daughter was told to avoid frozen foods, because they cause hypertension. The same week, Elizabeth posted a blog post about different ways to cook frozen vegetables. My daughter read this to me and then looked wide eyes and said “frozen food”? We often have frozen food, and even more now during the pandemic. My daughter recently has started making a smoothies out of frozen berries as a snack and is so proud of herself when she does this. If you’re thinking, “but that’s not what they meant,” you and I can understand these abstract intricacies, but children cannot. Nutrition is not black and white and when we teach children nutrition in a fear based, absolute way, we create more fear and confusion.

We need to stop teaching children to fear weight gain.

Another example of an age inappropriate nutrition lesson was from my 4th grader. Last week, he watched a Brain Pop video that said he should exercise to maintain his weight.  We don’t want 4th graders to maintain their weight.  If a child is not gaining weight it is a sign that something could be medically wrong. More importantly, we want children to love and enjoy body movement, to the best of their ability, to keep their minds and bodies strong.  (I’m starting to think of the best way to be heard by Brain Pop, stay tuned!)

Developmentally Appropriate Nutrition Education

A few months ago, when my 4th graders’ nutrition unit was approaching, I offered to do a lesson for the class. At that time, I had no idea it would need to be virtual, but I was still excited to teach his class a developmentally appropriate nutrition lesson. I created a virtual lesson and wanted to share it with you, in case you want to use it with your upper elementary aged child. The lesson is about the “Edible Parts of the Plants.”  The video is below along with 2 handouts to go with it.

Diagram: Edible Parts-of-a-PlantDownload
Worksheet Edible Parts of a PlantDownload

What makes this lesson developmentally appropriate? It teaches children concrete information about food and doesn’t include moralistic views of food. The lesson encourages the student to learn more about the foods they eat and think about where the foods come from. My 4th grader asked me to add the first 3 tips, because he wanted his classmates to hear what I tell him at home. If I was doing this lesson in person, I’d also include a no-pressure taste test.   

Please feel free to use and share.  I’ll be sharing more information as the full curriculum is completed.

More Resources for Nutrition Education

A friend and colleague of mine, Katherine Zavodni, and I are working on a nutrition curriculum for preschool and elementary aged children, as an alternative to the weight focused curriculum and lessons. This curriculum aims to use developmental theory to inform what and how we teach children about nutrition. We will keep you updated.

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