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Sugars 101 - Fructose, Glucose, Sucrose, Agave, and High Fructose Corn Syrup Demystified

>> Monday, November 25, 2013

There is so much information (and misinformation) out there about sugar, sweeteners, high fructose corn syrup, and so on, that it's hard to know which way is up sometimes. ...

A question that has come up frequently is whether fructose is better or worse for you than regular sugar.

A few key points:

1.  Table sugar is sucrose.  Each sucrose molecule is made up of one glucose and one fructose molecule.

Sucrose (table sugar) = glucose + fructose

2.  High fructose corn syrup (HFCS) is not much different from table sugar.

Sucrose (table sugar) = 50% fructose + 50% glucose

HFCS = 55% fructose + 41% glucose + 4% other sugars

The calorie content of table sugar and high fructose corn syrup are about the same.

3.  Fructose is handled differently by the body than glucose.

Glucose causes a rise in blood sugar (when we say 'blood sugar', we actually mean 'blood glucose' - I know, confusing, right?).  This causes us to release insulin to deal with the glucose - insulin allows our cells to take up glucose to use as fuel or as energy storage.

Fructose does not cause a rise in blood sugar (as it is not glucose) and does not stimulate us to release insulin.  Fructose goes to the liver, where it it used to store energy in the liver in the form of glycogen, or, if there is enough glycogen in the liver already, the liver turns fructose into triglycerides (a form of fat).  Triglycerides can accumulate in the liver, potentially causing damage; triglycerides in the blood stream can contribute to build up of plaque on the walls of your arteries.  (Note: the science is still sorely lacking on the exact nature and extent of the effects of fructose on the liver in humans. Scientists who want to read some of the biochemical and proposed mechanistic details can start here.)

So, because the calorie content of sugar and fructose containing sweeteners are similar, you are not doing your waistline any favors by selecting fructose sweeteners.  Agave syrup, which is a popular sugar substitute in the raw food community, is another example of a sweetener heavy in fructose compared to glucose (the proportion varies by brand).   Agave is still calorie containing and is not going to benefit you from a weight loss perspective.  I have seen sites on the internet advertising agave syrup with as much as 92% fructose - this would be of particular concern to me given that excess fructose could be damaging to the liver (as above).

 (agave plant)

Fructose is often touted as a preferred sweetener for diabetics because it does not cause blood sugar or insulin to rise.  Again, because of the concerns of the effects of fructose on the liver, this is NOT a recommended approach.  Also, again, fructose is still calories and will not be an improvement to a weight struggle.  And, remember that 'fructose' sweeteners are still almost identical to table sugar in their composition (see above #2).

The bottom line is this:  We get more than enough carbohydrates through a regular diet.  We should avoid adding additional carbohydrate calories to our food (be that table sugar, high fructose corn syrup, agave, or other) on top of the sugars and carbohydrates we already get.  Period.

PS This post is dedicated to my mom - thanks for asking the great questions! :)

Follow me on twitter! @drsuepedersen © 2013


Do Hormones Play A Role in Weight Loss Failure After Bariatric Surgery?

>> Tuesday, November 19, 2013

Obesity surgery is currently the most effective treatment available for severe obesity.  While the smaller stomach reservoirs that are created by these surgeries play a major role in the weight loss seen, it is becoming increasingly evident that there are many other contributors at work, one of which is thought to be alterations in various hormone levels after surgery.

I was asked to write a review article discussing what we know about hormone changes in relation to weight loss failure and weight regain after bariatric surgery, which was recently published in the journal Gastroenterology Research and Practice.  In the article, I review eight of the key hormones thought to be involved in the weight changes after bariatric surgery (from GLP-1 to PYY to oxyntomodulin, bile acids, and others), as well as what we know about the hormone changes that occur after the four main types of bariatric surgery (gastric banding, sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion).

In summarizing what we know about hormonal associations with weight loss failure and weight regain after bariatric surgery, there was painfully little to discuss - there is unfortunately very little data in this area.

What became poignantly clear to me from compiling this review is that more research is desperately needed to help us understand how hormones may contribute to weight loss failure or regain after obesity surgery.  As I noted in the article,

In the future, with a better understanding
of this complex arena, assessment of hormone status
could potentially be helpful in understanding the hormonal
contributors to a patient’s postoperative weight loss failure
or recidivism, potentially aiding the clinician in utilizing
appropriate targeted hormone therapy to help them achieve
successful or sustained weight loss.

This is probably not a wish I should expect to see fulfilled anytime soon - after all, pinpointing hormonal predictors of weight regain after 'regular' dietary-induced weight loss has proven evasive as well.  However, with a dedicated body of bariatric researchers worldwide, I hope that we will learn more about this important area with time. 

Follow me on twitter! @drsuepedersen © 2013


Sochi Subway Squats!

>> Friday, November 15, 2013

A little Friday Fun.  Check it out - as part of a campaign to make Russians healthier, and also to promote the Sochi Olympic Winter Games, the Moscow Metro is offering metro tickets for 30 squats (instead of the usual price of 30 rubles).  I love it!!

Thanks to both Mark and Erin for the double heads' up on this awesome campaign.

Have a great weekend!

Follow me on twitter: @drsuepedersen © 2013


The Interactive!! Flavor Connection Taste Map

>> Wednesday, November 13, 2013

I know, this graphic looks boring, complex and frankly overwhelming... but I promise you, it's so cool!  Read on...

Ever wonder why certain foods just seem to belong together?  For example, fish tastes great with lemon; beef goes well with potatoes.  It turns out that these foods share flavor related chemical compounds, and a new interactive map from Scientific American can show you which foods and flavors may mix best together when you are experimenting in the kitchen!

On this map, you'll find around 200 commonly used foods, spices, drinks and other ingredients, with bigger dots on the map representing ingredients with greater popularity based on a recipe database.  The higher the food is on a page, the greater number of foods that are connected to it by having flavor related chemicals in common.  Click on one of your favorite ingredients on the map, and the program will show you not only which other foods are connected to it, but also how strong that connection is (see the program's excellent explanatory guide that pops up when you first open the page).

Have fun!  My motivation in sharing this, of course, is to encourage more cooking from the home - there are no 'hidden ingredients' (such as loads of extra oil) in home cooked food that can sabotage a healthy lifestyle!

Thanks to my friend Priti for the heads' up on this awesome program!

Follow me on twitter: @drsuepedersen © 2013


Portion Sizes - Coca Cola from 1974 to 2008

>> Friday, November 8, 2013

I love this - my friend and colleague Dr Pam Downey found a couple of Coke collector's glasses in her home, one of which she purchased in 1974, and another in 2008.

A picture speaks a thousand words, doesn't it.

Follow me on twitter! @drsuepedersen © 2013


Barefoot Running - A Help or Harm?

>> Monday, November 4, 2013

Barefoot running has become popular in the running world in the last few years.  Advocates of barefoot running feel that since our bodies were evolutionarily designed to run long distances, it must be better for us to run barefoot as nature intended us to do.  So, what does the science tell us about barefoot running - is it really good for us, or does it set us up for further injury?

Let me ask first of all, were we actually designed to run long distances in the first place?  The theories are actually pretty convincing in this regard.  Some humans in the world still use our design for its proposed main evolutionary purpose of persistence hunting (check out my previous blog post on this, along with David Suzuki's documentary on it, here).

As for whether running bare foot is good or bad for us, a recent review summaries the research currently available on the topic.  The review is extremely detailed and I will be the first to admit that I am not a biomechanics expert - for those who want the in depth discussion, I encourage you to read the full article.  However, I would like to share the bottom lines of the article with you, as the question of barefoot running has become relevant for many people who run and aren't sure what is best.

The bottom lines are:

1.  There is still very little known about barefoot running and its relationship with injury and performance; whether barefoot running prevents or promotes injury is still unclear.   As the authors note,

The current promotion of barefoot running is
based on oversimplified, poorly understood, equivocal and in
some cases, absent research, but remains a trend in popular
media based solely on an evolutionary/epidemiological hypothesis

and anecdotal evidence.

2.  Barefoot running is not an instinctive skill, but likely to be one that requires practice to master.  Optimizing the foot strike is one key component to efficient barefoot running, and is different than the foot strike in a running shoe.  It is also not clear whether every runner is capable of optimizing barefoot running. 

3.  The actual running technique is probably more important than whether or not the runner is wearing shoes. 

So in summary:  A lot more research needs to be done to establish whether barefoot running is actually a good thing, and it is premature for the practice of barefoot running to be a disseminated practice for athletes. 

Follow me on twitter! @drsuepedersen © 2013



I am excited that you have arrived at my site, and I hope you are too - consider this the first step towards a Healthier New You!! As a medical doctor, Endocrinologist, and obesity specialist, I am absolutely passionate about helping people with weight management. Though there is certainly no magic cure for obesity, there IS a successful treatment plan out there for you - it is all about understanding the elements that contribute to your personal weight struggle, and then finding the treatment plan that suits your needs and your lifestyle. The way to finding your personal solution is to learn as much as you can about obesity: how our toxic environment has shaped us into an overweight society; the diversity of contributors to obesity; and what the treatment options out there are really all about. Knowledge Is Power!!

Are you ready to change your life? Let's begin our journey together, towards a healthier, happier you!!

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