Michael Goran, PhD, is a Professor of Pediatrics at The Children’s Hospital of Los Angeles, and Director for Diabetes and Obesity at The Saban Research Institute
Emily Ventura, PhD, MPH, is a nutrition educator, public health advocate, Fulbright Scholar, writer, and cook.
Truffld: Referenced in Sugarproof Kids is the immense inflammation that results from sugar consumption, which then lowers our immune system response to bacterial and viral infections. As we embark upon a winter amid COVID-19, expediency is key. What is the most seamless, optimal sugar swap (aside from whole fruit-derived) we can make now?
Dr. Ventura: For anyone consuming liquid sugars, that is the first and most important swap to make. Any sweetened beverages in the form of juice, soda, soft drinks, sports drinks, energy drinks, coconut waters, vitamin waters, or sweetened coffee or tea drinks deliver a concentrated dose of sugars that is hard for the body to handle. These beverages tend to be the highest contributor to added sugar intake, tend to be high in fructose, and their concentrated liquid form can overwhelm the capacity of the body to safely metabolize them. Swapping these beverages for unsweetened options like water, flavored waters or herbal tea can have the biggest impact on sugar reduction. This can be done over time if needed by gradually diluting them.
Swapping these beverages for beverages made with low calorie or alternative sweeteners is not a good option, because these sweeteners have their own problems and don’t reduce cravings for sweetness. A second important swap is to reduce sugars at breakfast, because starting off the day with sugar puts the body on a roller coaster ride of spikes and dips in blood sugar that often lasts all day. This can involve simple swaps like what you put on your toast in the morning (eg replacing jam with cream cheese, ricotta cheese, or nut butter, etc) or switching from a high sugar to a low sugar breakfast cereal.
Truffld: Explained in your book are the myriad of health repercussions in children due to sugar, and though adults are also harmed by sugar intake, unlike children, their microbiome, brain, stem cells, and other vital systems have already formed. In the developing child, is there a “point of no return” (or at least, slower return) when it comes to reversing the damage?
Dr. Goran: This gets to the heart really of why children are more vulnerable to the damaging effects of excess dietary sugar. It’s hard to say for sure as we don’t have long-term studies in humans to fully answer this question. We do have some examples from studies in animal models that indeed show that exposure to high sugar during critical periods of development can have long-lasting and irreversible effects. For example, in one study, rats were given access to a sugar solution only during their period of adolescent development which in the rat lasts for just 30 days and is marked by a major period of brain development. Sugar consumption during this period had a negative effect on memory and caused brain inflammation in the hippocampus. When sugar was removed after adolescence, the rats exhibited the same defects months later when they had become fully grown adults. The same issue may also be true with regards to the gut microbiome. We know the gut microbiome develops during the first few years of life and can be affected by diet, including sugars.
Truffld: We are what we eat, and you’ve coined a new term, “We feel how we eat.” How can we expect our children to feel and even behave, once they’ve established some improved sugar habits?
Dr. Ventura: Often when families do our 7 day no added sugar challenge, they discover just how much of their children's temperaments and food cravings were sugar related. This includes irritability, drowsiness, lack of ability to concentrate, and moodiness. And also what has been termed “hanger” - the combination of hunger and anger. It is not necessary to give up sugar entirely to see improvements in these areas, but doing one of our challenges is an effective way to see for yourself how things might change. We encourage families to be their own scientists and observe patterns in their own children. Reducing sugar can definitely result in dramatic improvements in how kids feel and help them achieve a more stable temperament.
Truffld: Oftentimes we might assume that governing agencies are looking out for us when it comes to regulating the food we eat. However, as confirmed in Sugarproof, there is much less oversight by the Food and Drug Administration (FDA) than we might think. One step in the right direction though, is an improved food labeling system implemented in 2020. What should we look for, and how can we best advocate at a grassroots level?
Dr. Goran: The new food labels require that products differentiate total vs. added sugars. This is very helpful in that previously it was hard to know how much sugar was coming from natural sources like fruit or milk, and how much was coming from added sources like cane sugar or high fructose corn syrup. Eventually we would like to see even more information disclosed, such as the amounts of specific types of sugars like fructose as well as better guidelines for limiting the marketing of high sugar foods to children. Ultimately, as consumers we should act with our wallets and avoid purchasing high sugar foods that are impacting our health.
Truffld: For too many underserved pockets of the country living amongst fast food jungles and trying to function at or below the poverty line, fresh, whole foods are simply out of reach. What recourse do they have toward a healthier life?
Dr. Ventura: This is a heartbreaking issue and one that deserves as much attention as possible. We need to lobby for better federal policies to make fresh foods more accessible and reform programs like the school lunch programs to make them even healthier. We can also lobby for community gardens and nutrition education to give kids the skills to grow and cook their own food and understand the importance of good nutrition for life-long health. Simple recipes can be very cost effective and with the knowledge and skills of how to prepare them, healthy nutritious food does not have to come at a high expense. Also, we need to be advocating for better guidelines for how SNAP dollars should be used so as to avoid junk food including sugary beverages.
Truffld: Outlined in the book is an extensively detailed recipe and ingredient catalog, accompanied by palatable (pun intended) ways to involve our children in the transition toward better meal and snack choices. What are some of the biggest challenges parents face in implementing this, and how are they overcome?
Dr. Ventura: Eating well usually does take more time and planning, but we try to make things easier for families by offering recipes that are flexible, can be made ahead of time in bigger batches, and can be used interchangeably between meals. We also encourage getting kids involved in the shopping and cooking which makes them more likely to accept and be excited about the meals and snacks and even able to lend a hand in making them as they get older. We also offer suggestions for convenience foods and for foods to order when eating out that have less sugar and are healthier overall.
Truffld: Tell us more about the 7-day and 28-day challenge.
Dr. Ventura: In Sugarproof we outline two different family challenges. One is a 7 day challenge where families remove all sources of added sugar just for one week to help raise awareness about which foods have added sugar and also to quickly reset palates to a lower level of sweet taste preference. Giving up sugar for even just a week can have many benefits including re-awakening of palates to appreciate less sweet foods. The second is a gradual challenge where families reduce sugar over the course of 4 weeks. This approach is more flexible and allows for a more gradual change over time which may be more suitable for families where not everyone is up for participating initially or for families with busier schedules that would make taking all sugar out for one week harder. With both challenges the overall goal is the same: reset sugar consumption to a healthier new normal and help kids become better self-regulators of sugar intake.
Truffld: In Sugarproof you already touched upon some of the sugar-induced conditions that can also affect adults, from earlier onset of Alzheimer’s, and shortened telomeres (associated with aging), to Polycystic Ovary Syndrome (PCOS). For those of us in our 30s, 40s, and beyond, how hopeful should we be that our future can indeed look bright if we make sugar-related dietary changes now? Is a sequel, Sugarproof Adults in our future?
Dr. Goran: Reducing sugar can have the same advantages in adults and it’s never too late to start reducing sugar. Although Sugarproof is focused on kids, it’s ultimately a family-based approach where all members of the family can benefit collectively. Another segment of the population that we didn’t have too much focus on in Sugarproof is the elderly, where separate issues and concerns may exist and at some point we would like to publish something that is specifically geared toward them and their needs.
*Drs Ventura and Goran are initiating a broad campaign for a community 7-day no added sugar challenge in the New Year. Anyone who has bought the book or purchases the book over the next month will be eligble to receive a detailed meal planner/recipe/shopping guide and be part of a group that will receive ongoing support.
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