What the Iranians can teach us about fructose

Aaah the old 'sorry I've not blogged for ages' blog post. I've been on limited internet for a while due to the whole packing-moving-unpacking thing. And to be honest, I've also felt like I don't have anything new to share. Maybe writing about going sugar-free isn't blog worthy. I mean, it seemed like such a big step, a topic which would keep me writing for ages. But turns out that, once past the initial withdrawal and so on, and after trying a few recipes and finding that glucose is nearly as easy to work with as sucrose, it's not such a big deal. It's actually really easy. I've lost nearly 8kg so far, and it keeps going slowly down.

But then again, I do love to write, and so I find myself back here. I was inspired tonight by a study which David Gillespie posted to the Sweet Poison Facebook group. The original study is here. In a nutshell this study showed that high levels of fructose in the diet of men and women in Tehran, Iran was associated with an increased risk of metabolic syndrome, including higher body mass index and abdominal obesity.

Yeah, so? you might be saying. Isn't that the point of this blog, that fructose is bad, bad, bad, and that there is research to prove it? Well, yes, of course. But remember that most of the previous published research in this field has been in rats. And it's easy to dismiss this- a rat is (by definition) not a human. And while there have been other studies on people which showed that the rats were on the right track, they were limited, and open to criticism, for example that they fed people an unrealistic amount of fructose. A 2010 review of research published in the same journal as the new one concluded that "No fully relevant data account for a direct link between moderate dietary fructose intake and health risk markers".

So what we have now is one of the first human (ie, non rat) studies to show strong links between dietary fructose (the fructose that actual humans actually ate as part of their actual normal everyday diet) and metabolic syndrome, independent of age, physical activity, energy intake, dietary intake of other nutrients (eg fat) and BMI (all of which the researchers controlled for in their analysis).

The levels of fructose that this study suggest leads to problems seem quite high: >50g per day. At first glance it may seem like most of us are ok- surely I don't eat more than 50g fructose (100g sucrose), you might say. That's a heck of a lot of sugar. Visualise 22 teaspoons if you can, because that's how much it is. But consider that the average intake of fructose in this study was around 50g. So around half those studied (normal, everyday people) were eating over 50g per day. In their usual diet. And in case you think this only applies to Tehranian Iranians, US figures suggest that on average, Americans eat 55g of fructose per day- again, meaning that around half eat more than this. The data for Aussies is sketchy. In 1995 an Australian Bureau of Statistics survey showed that 20% of Australian energy intake came from sugar (in processed foods, fruit and veg, honey and other sweeteners). 20% of energy intake for a male aged 31-50 is between 104g and 185g per day (in fructose terms, 52-92.5g per day). More current figures are sparse to nonexistent because the ABS no longer conducts this particular survey, but a study being conducted with staff at the Epworth hospital (the SWEET study) may provide more answers (if and when it is published- will be looking out for that one). Preliminary data collected from participants showed that they ate 17 teaspoons per day in added sugars alone. Add in your fruit and veg (these are counted in the fructose total, even if they are healthy!) and I'll bet we are close to averaging the magic (in a bad way) 22 teaspoons.

I can't help but feel that this new study means that David Gillespie and others sounding the warning on fructose like Dr Robert Lustig should take some time out this week to give themselves a little pat on the back and maybe just send a little 'told you so' email to the nay-sayers who have insisted that fructose is fine and dandy like sugar candy. Like the university professors interviewed for this article reassuring the public that sugar is no threat, and that the National Health and Medical Research Council draft nutrition guidelines are being ridiculous for daring to suggest that Australians limit added sugars.

The bottom line is that we (most of us) eat a LOT of sugar. And we can now be more confident that this sugar may be doing us, the humans, and not just the rats, a lot of harm. 

It's food, Jim, but not as we know it

I’ve realised that part of going fructose free is going to mean drastically reducing my intake of processed foods. Many of them are laced with sugar, for a start, but I also feel like if I’m going to take this step- and it’s a pretty big one – then I can’t ignore the other crap I’ve been eating.

I don’t really know how this stuff crept into my life, to be honest. A diet yogurt here, a jar of pasta bake sauce there...a heady combination of easy availability, lack of time for cooking, and the perpetual search for the perfect ‘diet’ food.  It’s kind of embarrassing to me that I’ve made it to 32 without really evaluating the quality of what I eat.

The question is, where to stop.  Are tinned tomatoes ok? Do I go organic as much as I can? Do I want to make my own bread? (Answer: no). I’ve got some thinking to do, but not today. Today is daylight savings Sunday. I’m finding it hard enough to work out what time it is (every clock says something different- argh!), let alone work out whether paying an extra couple of bucks for organic meat is worth it.

Instead, I thought I would amuse myself and take a look at some of the buzz word laden manufactured foods which used to be in my cupboard. You know, the 99% fat free, low GI, added fibre, no added salt, all ‘natural’ ingredient, ‘healthy’ processed foods. Hopefully this exercise will make me think twice before going down this pointless road ever again.

There are so many to choose from that I thought I’d start with breakfast. Then, if I find trashing food in this way to be fun, I’ll keep going with other meals :)

Before I start, I think I need more photos in my blog.

Photo: Arvind Balaraman http://www.freedigitalphotos.net/images/view_photog.php?photogid=1058

Mmmm Fruity. No, that would be way too easy. I’ll stick to products that at least try to make us think they are healthy. 

Let’s start with one of my favourites. Special K. Keeps you looking good. I’ve eaten this often, and I believed the hype: low GI and high in protein which will keep me full for longer, so I won’t be needing that mid-morning biscuit. Great! And that’s why I’ll be able to keep wearing that mini skirt well after fashion and good sense tells me not to (YouTube let me down with the ad- anyone remember it?). What is so special about Special K? Well:

Cereals (62%)(rice, wheat), wheat gluten, sugar, wheat flour, minerals (calcium carbonate, iron, zinc oxide), salt, barley malt extract, vitamins (niacin, vitamin B6, riboflavin, thiamin, folate).

Not a ridiculously long list, especially if you ignore the vitamins and minerals which are obviously good. Hmm though, why are they adding vitamins and minerals? Wholegrains contain vitamins and minerals. Could it be that the 62% cereals are not wholegrain? Sure enough, a serving of Special K is only 10-20% wholegrain, which is pretty low. Cheerios are 70-80% wholegrain.  I’m not going to bang on about wholegrains because they frankly bore me, but the deal is that wholegrains include fibre, vitamins and minerals. If you are eating a non-wholegrain (part grain??) then it is pretty much just starch. As well as plenty of starch in your bowl of Special K, you also get a teaspoon of sugar courtesy of the manufacturers in every serve you eat. 

Up & Go (Vive)

Mmm Up & Go. All the goodness of drinking a Weetbix. If you can stomach the idea of a breakfast that you drink, here is the ‘Vive’ version of the Up & Go. I chose Vive because they are marketed as ‘light’, compared to the normal Up & Go. They are also marketed as low GI and high in fibre, with lots of vitamins and minerals including calcium. The ingredients list is below, from the Sanitarium website. 

Filtered water, breakfast cereal (6%) (wheat maltodextrin, hi-maize™ starch, inulin, corn syrup solids, barley beta glucan, oat flour), skim milk powder, soy protein, sunflower oil [contains antioxidant (tocopherols) (contain soy)], cane sugar, fructose, berry purees (0.7%) (strawberry, raspberry, blackberry, blueberry), apple puree, minerals (phosphates of calcium and sodium), acidity regulators (332, 300), flavours (contains wheat), vegetable gums (460, 466, 407), fermented red rice, vitamins (C, A, Niacin, B12, B2, B6, B1, folate), salt

Both the Vive and the Up & Go original are 98.5% fat free- but the ‘light’ aspect of Vive is that it has much less sugar (12 grams per serving- just a measly 4 teaspoons) than the regular Up & Go (27 grams- gah!). But all those ingredients- what are they for? Consider this alternative: Milk, berries. Blend. High in fibre, low GI. Lots of vitamins and minerals, including calcium. The light and satisfying way to help you get through your morning, without all the crap of the Up & Go Vive.

Finally, some healthy yogurt, a staple in my fridge for years. I chose Forme No Fat ‘Satisfy’ Yogurt which is not only low in fat (ok, no in fat), but is designed to keep you full for longer because it is a yogurt with added fibre. Mmm. The thought of the added fibre actually turned me off this product for ages, but I have tried it and it is ok. Not yum, but ok. It’s a diet yogurt, what more can I expect? In it you will find

skim milk, milk solids, water, dietary fibre (inulin), fructose, thickener (1442), halal gelatine, flavours, acidity regulators (330, 331), sweeteners (951, 950), live yogurt cultures: s.thermophilus and l.bulgaricus 

Ok, the fructose is a surprise, and not a nice one. There are also two artificial sweeteners. Inulin is the fibre. Unfortunately, research shows that inulin doesn't perform that well when it comes to keeping you feeling full.  Soluble fibre needs to be gummy in order to slow down digestion and add a feeling of fullness. Inulin is unfortunately not all that gummy. No wonder I wanted a real yoghurt after I ate this one. Just for comparison, here is the list of ingredients in normal, full fat plain yoghurt (Jalna Greek Style):

Whole milk, cream, live cultures (lactobacillus acidophilus, bifidobacterium, lactobacillus casei).  

I’m eating that one from now on. 

On the topic, here’s a little story from a research study that I came across (here). The researchers wanted to compare inulin to another fibre called lupin-kernel as a replacement for fat in a breakfast sausage. Participants tested the fibrous sausages, and gave feedback such as ‘Dry, fibrous, gristly, stringy, tough” (24% of participants) and ‘bland taste’ (14% of participants). Nevertheless, the researchers concluded: “Both inulin and lupin-kernel fibre appear to have potential as fat replacers in meat products”. Sure they do, if you don't care about taste or texture.

So, what have I learned? First, the goal in manufacturing 'healthy' foods seems to be to trick us into feeling full. Adding fibre and protein to things that don’t traditionally have fibre or protein is the tactic of choice. But if you think about it, it's weird that you can buy a cereal that contains protein and a dairy product that includes fibre. Second, the focus on being low in fat means that sugar sneaks by without a murmur. I would never add four teaspoons of sugar to my cereal, but that is what I get in the ‘light’ version of Up & Go. And third, this is a little subjective, but it doesn’t seem to matter whether the food is tasty or actually nutritious. The food and the experience of eating no longer matter, as long as the nutritional panel on the product looks something like ‘healthy’. I wonder how long it will be until they just stick actual cardboard pieces in a cereal box and sell it as the ultimate low fat, high fibre breakfast.

I know I can’t expect much more from manufactured, processed, convenience foods, and I should have known better, to be honest. And yeah, I'm not exactly leading a trend here in rejecting them- I'm sure most of you saw the light a long time ago. 

Anyway, there’s no shame in admitting I was wrong. So, goodbye Forme. As my dad might say, you are not the one for me (ha ha).

Whatever doesn’t fill you, makes you...hungrier?

19 days in! I'm feeling good. Not great, but good. Sleep is definitely not my friend at the moment, and I’m not sure what that’s about- maybe a withdrawal side effect, maybe nothing to do with this sugar-free life. On the craving side, not much to report, which is a plus (although as I typed that, I suddenly really wanted licorice, really badly, damn).

Here’s another plus: I’ve definitely felt fuller lately, even though I'm eating less. Strange, but true. Of course I’ve changed quite a few things about my diet. I’ve cut almost everything sweet out (except fruit and veg of course) because if it’s sweet, it’s most likely sugared. I’ve also added fat back into my diet: no more ‘low fat’ versions for me. And along the way I’ve also probably added more fibre as well through fruit and veg and other healthy stuff.

I wanted to look at the whole fullness thing in more detail because I don’t really understand it. Why do different foods make us feel ‘full’?  Is there a magic combination of foods which will help me to feel not just full of food but satisfied and not looking around for more? Or do I just need more self-control to stop me licking the plate clean and then helping myself to the post-dinner TimTam?

There are two parts to determining how much we eat at a meal. If something is delicious, we eat more of it. (mmmm licorice...stop that). So our perception of food and the positive feedback we get from eating is really important. We also get feedback from our bodies, telling us when to stop. As these guys point out, to reduce your energy intake you either have to decrease the ‘morishness’ of your food, or increase the feedback from the body (or your response to that feedback) that stops you eating.

Eating boring food might be a great way of reducing your meal size and (in the long term) your weight, but try serving your family a couple of boiled parsnips for dinner tomorrow and see what they think about this idea (feedback can be posted below!) Perhaps our tastebuds are spoiled brats with all the food choices that we have, perhaps we just have too much (inborn? socially developed?) expectation that food should taste good, not bad. Either way, I’m not convinced that it’s plausible long term to work on energy intake by eating only unappealing food.

Nope, it’s going to have to be up to the body on this one- so, what can you do for me, digestive system? Turns out it can do quite a lot, but in the interest of keeping this post readably short, here is the cutback version of some processes which are far, far too complex for me to understand with just some light reading in my spare time. But, keeping to the shallows, I’ve gathered a few interesting facts for your edification.

The most obvious signal to stop eating is the physical feeling of fullness in your stomach as it fills up with all that yummy food. If you get through the entree and main and feel like you are bursting, this is your stomach trying to say ‘hey, don’t get dessert on my account, I’m done here’. Fibre is great at filling the stomach, but fat and protein also play a role. (I’ve learned some great things about fibre while researching this, but I’ll save that for another day. Bet you can’t wait!). The body doesn’t just rely on the ‘full’ feeling to make you stop. A hormone called Cholecystokinin (which is also helpfully called CCK, a far easier-to-type name) is stimulated in the small intestine, particularly if you eat a lot of fat and protein. CCK helpfully sends a signal to the brain to say ‘enough already’, just a brief message to get us to stop for this particular meal. We have the ability to ignore or overcome this signal and keep eating, and we regularly do. It’s a handbrake rather than a tire clamp. Stimulating CCK during one meal has little effect on what you eat for the rest of the day (as I read here), but may make us more sensitive to the full feeling in future meals. There is an article specifically about this hormone here if you are interested.

Another important hormone in helping us put the fork down is leptin. Leptin is made primarily in your fat stores, and the greater your love handles, the more leptin is whirling around the body, which should mean that you eat less. Leptin seems to be the body’s way of keeping tabs on your nutritional status. It sends ongoing messages to the brain saying ‘hey there, no need for big, high energy meals right now, there’s plenty of fat to get us through winter’ (I’m paraphrasing, of course). If there’s a lot of leptin, it also increases the amount of energy you burn. What a gem- I love this little guy!

The catch is that it seems we can become resistant to the effect of leptin. In fact, to quote these researchers, “Most forms of obesity are associated with diminished responsiveness to the appetite-suppressing effects of leptin”.  You knew I couldn’t go a whole post without mentioning fructose- my sweet nemesis- so here it is. When fructose is processed by the liver, the liver produces triglycerides. These fatty little fiends have been shown to block the uptake of leptin in the brain, meaning that while the leptin is talking, the brain isn’t listening.  These researchers showed that this leptin resistance can develop without any outward sign (such as weight gain)- until we also start eating high calorie meals- then BAM! we gain serious weight because leptin is not able to tell the brain what is going on. If this is true, then eating high calorie food in conjunction with fructose is a recipe for obesity. And fructose is terribly easy to eat.

I'll just mention as well that there seem to be important links between leptin and CCK, including evidence that if either hormone is reduced or blocked, then the other doesn't work as well as it should.

So there you have it, a whistlestop tour of how your body wants to help you [insert pic of Uncle Sam in your imagination]. There are a bunch of processes, hormones and signals that we as choice-wielding humans can listen to or ignore, and a bunch of foods which can turn the volume up or down. And if this all feels too complex, there is always the boiled parsnip option :)

Cleaning house

I spent this morning cleaning out our ‘snack shelf’. I needed to do this anyway- the shelf is too high for me to reach to the back and there are things in there of which I know not- the ghost of snack attacks past. I found some candy canes from Christmas two years ago. They were probably still good (do candy canes go off?) but I chucked them out anyway, along with

•         Two packs of ‘Double-D’ candies. Completely disgusting anyway, but also made with Isomalt, a low calorie sweetener which acts body just like sugar with approximately 50% glucose and 50% fructose.

•         Two packs of 'Sultry Sally' 97% fat free potato chips (salt and vinegar). Most flavoured chips have sugar in the flavouring so I was surprised and a little excited to see that these used dextrose (glucose). Then I realised that they a) contain MSG for no good reason and b) taste like cardboard. So, I chucked them.

•         Three individual snack packs of apricots in juice by Weight Watchers. No sugar added and only half a WW Point each (I think under the new ‘Pro Points’ system they are worth 0 points). But, sweetened with cyclamate and saccharin, artificial sweeteners which don’t act like fructose in the body (as far as we know) but which I can probably do without anyway. 

Goodbye ‘diet’ snacks. You won’t be missed. My snacks now (in case you are wondering) are things like popcorn, plain potato chips, nuts, rice crackers etc- as well as fruit, cheese, etc. Yummier and healthier snacks than the manufactured crap I used to eat in the name of my diet. I haven’t felt the need to snack as much as usual, anyway, which is great news.

I’ve also had a good look the snacks I give my son, who is 12 months old. I must admit that my attention previously was on the salt, rather than the sugar. Babies' kidneys can’t cope with salt in the same way that adults do, and it is dangerous for them to have large amounts. The Food Standard Agency, UK says that toddlers 1-3 years can cope with 2 grams of salt per day (0.8 grams of sodium) max.

So that's salt, but I'm off the sugar grid, remember? So, of course I'm now interested in sugar for toddlers. It's hard to find recommendations about the daily intake of sugar for this age group. The 'Toddler Healthy Food Pyramid' on Kidspot doesn't even mention sugars. And the information on the Raising Children Network site is also sparse in this respect. Perhaps we are all pretending that the only sugars littlies will come across are the natural ones in fruit and vegetables, and the lactose in milk and dairy? Please. If you expect toddlers to have no foods with added sugar, then say NO FOODS WITH ADDED SUGAR. 

Well anyway, what’s in our cupboard? My son is still at the age where he eats plain rice cakes enthusiastically, and I haven't ventured far into commercial snack packs or bars so far. The ones I had bought, though, included a few hidden nasties from a sugar perspective. Rafferty’s Garden Fruit Snack Bars (recommended for 12 months plus), a former favourite, turned out to be 40% sugar. Some of this is the (dried and concentrated) apple paste, but if you look at the ridiculously long list of ingredients that these bars contain, sugar is listed twice (added to the ‘fruit paste’ and to the biscuity outer layer of the bar). At 6.5 grams of sugar per serve, baby gets about 1.5 teaspoons of sugar in a tiny bar. Yum! 

Sultanas are another suspect food in terms of sugar, unfortunately. When someone opened a container of sultanas at mothers group this week, the babies all channeled their inner locust, swarming over and devouring as many as they could. I don't think I've met a baby of this age who doesn't love their 'tanas. Sultanas are 100% fruit, of course, but with all the water removed they are 80% sugar instead of the 20% sugar of the grape that made them. The usual story with fruit is that the fibre content, as well as the overall bulk (mostly water) of fruit limits the damage from the fructose that they contain. It fills you up, naturally limiting the amount of fructose you can eat in one sitting. You might eat a medium orange (about 7 grams of fructose), you might even find room for two (14 g fructose), but you probably wouldn't want your dinner afterwards. Compare how easily you (or your one year old) can eat a 40g packet of sultanas (about 13g fructose) and still find room for more. 

I'm not binning the 'tanas, in case you were wondering. We're just having them as an occasional treat instead of an everyday snack. The Rafferty's bars are gone though. Now we need some new ideas before the rice cakes get old- I'm always happy to hear new ideas for toddler snacks, so please feel free to post your suggestions below. [Thanks to those who pointed out that the comments weren't working for everyone- I had it on the wrong settings. I've fixed this now, so it should be easy to comment if you want to]. 

All in all, a good day's work. I know I'm not going to be able to keep my baby off the sugar grid at all times, but at least now I’ve made sure the snackables for both of us are as healthy as possible :)