Dr Rupy: If you're listening to this, you might think you're not eating that much sugar. Maybe you don't have fizzy drinks, you rarely eat sweets, or you buy the healthy snacks. That was me too. But for most of us, sugar is sneaking through foods we don't always see as high in sugar. And it adds up more than you might think throughout the day.
Dr Rupy: If you find yourself tired, struggling with dips in concentration, noticing changes in your mood or even just a sense that you're not feeling your best, your sugar intake might be playing a bigger role than you realise. Because when you find ways to reduce sugar, you don't just reduce your risk of type two diabetes, heart disease later in life, you actually feel better in the moment, in the weeks where you cut sugar, more energy, more focus, less inflammation, and a body that's set up to age well. And that's why I want to go deeper than the usual sugar is bad conversation today because I think it's pertinent to understand the hidden sources of sugar even in quote unquote healthy diets, why cutting sugar matters for your health, what the evidence around whether sugar is addictive actually states, and if some sugars are better than others, whether natural sugars are better than the refined white sugar, and the hidden signs that your body is getting too much sugar as well. And most importantly, I'm going to share five steps that have worked for me to cut down sugar without giving up everything you enjoy. And I've personally been putting these into action ever since I was a medical doctor trying to look after my health as a result of my own heart condition, and also ways in which I feel are evidence-based using the available literature to help people give up sugar and recognise whether you are consuming too much sugar as well. For now, this is my podcast on how to reduce your sugar consumption for healthy ageing, better energy and lower inflammation.
Dr Rupy: Most of us are eating too much sugar. Now, a lot of health bodies state that you should be keeping your added sugar under 10% of calories, but there was a recent umbrella review that stated we shouldn't be having more than 25 grams of sugar per day. This is the recommended amount of added sugar we should be having per day according to that review that was recently published in the BMJ. This is on average how much we are consuming every single day. There is a big disparity here, but this is just over one day. And you can see with the difference in the amount of sugar that we should be consuming every single day, that compounds week after week, month after month until you realise you're consuming kilograms of sugar more than you should be every single year and it is having a detrimental impact on our health. And so today, I want to dedicate this entire podcast episode to help you reduce the amount of added sugar that you're consuming from double or triple the recommended amount to levels that are sustainable and better for your health. And it doesn't require completely quitting sugar in its entirety. We don't need to remove every single source of sugar, but we definitely need to be a lot more mindful about how it sneaks in. There was a national diet and nutrition survey, so the NDNS, and that reveals that Britons are having far too much, especially in children. And I think, as a new parent myself, a nine-month-old who is definitely not getting any added sugar in his diet because we have strict control over everything that we put in it, 11 to 18-year-olds are where our habits form, our taste buds, I mean even earlier than that, but this is something that we should be really, really mindful of and get serious about, particularly with teenagers because this is where the habits that underlie healthy behaviours are formed into their adulthood. And so when I look at the research, particularly in 2018, children in England were on track to consume an average 13 cubes of sugar per day. This is more than double the maximum recommendation for kids. It is really, really worrying and this is why I feel like we're we're really battling an uphill struggle when it comes to things like type two diabetes risk in our 30s and 40s. And we're witnessing this in a lot of ways with earlier cancer diagnoses, earlier diagnosis of type two diabetes and dementia and the other metabolic consequences of excess sugar consumption are on their way as well. We just perhaps haven't seen that in the data today for for children over the last 10 to 20 years. So where is this all coming from? So even if you eat a healthy diet, you are probably eating more sugar than you think. So if you think of a typical day, right? Breakfast might be a bowl of granola with oat milk. That's two to three teaspoons of free sugar. I'm going to talk about the differences between free, added and natural sugars in a moment, but this is a very common starting point for a lot of people. Lunch could be a shop-bought soup or a wrap, that's another two or three teaspoons of added sugar because of the sauces they put in, because of the sugar they put into store-bought soups. And then maybe you have a smoothie or an energy bar that you've bought from a store. There might be some syrup in there, there might be some added refined cane sugar, there might be some sugar in the chocolate that you're eating in the energy bar. Add another three to four teaspoons. With all of these small additions, before you've even hit dinner time, you've hit your daily limit before the day is even half over. I mean, most people hit their daily limit at breakfast time without a single dessert. And it looks quote unquote normal and that was actually my thinking as well when I was trying to reduce sugars in my diet, reduce refinement in my diet. I thought I was having a healthy diet. Granola, tracker bars, flapjacks, a grab-and-go sandwich that was on wholemeal bread. There's a lot of sugar across all of those different products and until you get really serious about it, you won't be aware. Top sources of sugar in the UK according to Action on Sugar are preserves, confectionery like jam and chocolate spread. That's 27% of our daily added sugar. Fruit juice and soft drinks like squash, cordials and cola, again, another 25% of our daily intake of added sugar. Third, packaged snacks, biscuits, buns, cakes, breakfast cereals, granola, 20% of our daily intake of added sugar. Alcoholic drinks, 11% of our daily intake of added sugar. A lot of people don't realise that the glass of red wine that they reach for, the alcopop, these are really, really sugar-laden. They have no nutrient value and they turn to sugar really, really quickly in your body when you consume them. And some people are just completely unaware of the caloric intake that they're having from alcoholic drinks, particularly as red wine has this sort of health halo around it and I just don't buy into that whatsoever. Another source according to Action on Sugar, flavoured dairy products, sweeten yoghurts, ice cream, 6% of our daily intake of added sugar. And savoury foods like ketchup, other condiments, salad dressings, pre-packaged soups, ready meals, another contributor to our sugar intake. So if you total all these things up, they look like quite common items in a typical British diet. Bit of jam, chocolate spread, fruit juice, packaged snack, maybe a biscuit here and there, a little cheeky red wine in the evening, a breakfast cereal granola bar, maybe some like strawberry yoghurt. Nothing out there is screaming that it is really detrimental to your health. In fact, some of these items actually look really healthy, but secretly they are sneaking added sugar into your diet without you being completely aware of it. So this is something to get really, really serious about and I don't think a lot of people understand just how to recognise these products as being sugar-laden in the stores either. Ultra-processed foods are the dominant source accounting for nearly two-thirds of free sugar intake in the UK. And because you can't always tell that they've got actual sugar in, when you look at this list, you realise ultra-processed foods are the dominant source of added sugars, accounting for nearly two-thirds of that sugar intake in the UK. And again, another reason why people might not be aware is because sugar can take up to 50 different names on food labels, including agave, syrup, beet sugar, coconut sugar, rice syrup, concentrated fruit juice, cane juice, honey. All of these different names are the same for sugar. It is going to act in your body in the same way as refined sugar. Honey might have marginally more benefits in terms of some antimicrobial properties, maybe some micronutrients, but the vast majority of that product is just sugar. It is just simple sugar molecules that will act in the same way as refined white sugar. So there is no healthier alternative in my view. The only reason why you'd use something different is for a flavour profile and that's why a lot of these companies actually use smaller amounts of very refined syrups because the sweetness level is higher so they can actually use less and this is part of their reformulation strategy, which isn't a bad thing to be honest, but they are still adding lots of sugars because of our taste buds and our preference for sweet things. So all those different names of which there are many more out there can all mean the same thing. It's just sugar and it has the same chemical effect in your body as refined white sugar. I often get asked why sugar is suddenly everywhere. To set the scene, sugar obviously wasn't a daily staple. Our early ancestors would have got their sugar from fruit, but the limitation would have been seasons. You can't grow fruit out of seasons unless you've got access to winter berries and not everyone according to where you are in the continent would have had access to that. So sugar was a really rare resource. I mean, the other way is to to get it from honeycomb, but not a lot of people would have access to honeycomb and and bees. So we were really limited by the seasons. And as a species, we've evolved to be metabolically healthy according to sort of different fluctuations in our consumption of sugar even from natural sources like fruit. But this all changed around the 1900s or in the 20th century. So in the 1700s, sugar beet made it more accessible. So there was a crop that was grown, we use the sugar beet roots, that's how we get the sugar. And then in the early 1900s, automation came along. And automation allowed the extraction of sugar from the sugar beets and other plants and turned it into an everyday cheap staple. So suddenly we have this boom in confectionery and all these items that were otherwise in the sort of realm of the wealthy elites who had access to sugar. And even then, we weren't consuming kilograms of the stuff every single year. It was still relatively expensive, but much less so than what was previously. And then around the 1960s, when fat was blamed for heart disease, food companies, as a very reasonable way, cut the fat. They were like, okay, fine, we'll cut the fat because that's clearly linked to heart disease and we're going to replace that with sugar to mask the bitterness and make the food more palatable and shelf-stable and all the rest of it. And so sugar was reformulated into products to make it nicer tasting and cut the fat. We've made it more heart-healthy, we've cut the fat. Now, aside from the controversy around scientists who were paid off from Harvard by the food companies to downplay the effects of sugar on health, that's a side. If you're a food company and you've suddenly been given this playbook, cut the fat, then it's a very reasonable response to just add sugar into everything. And so sugary drinks become the norm, sugary confectionery, sugary products, sugary sources, this all becomes the norm and then our sugar intake just skyrockets without having, you know, more and more dessert. It was just in the food. Now, over the the last 20 years, we've recognised the impact of sugar and so we've had sugar taxes and other public health initiatives. Jamie Oliver obviously did some great work in the UK in the early 2000s, but we still eat way more than the recommended intake with a lot of it hidden in cereals, sources and breads like I've just mentioned. And in most Western countries, the number one source is still sugary drinks, which is something that I think is just crazy that we still allow to be A, publicised and marketed, particularly to young kids, but B, just so widely available as well. It's like literally having cigarette stands on every corner. That's the same way we should be looking at this because if you match their detrimental impacts to our health, they are having just the the same amount of detrimental on on people's well-being. So, and it's important to remind ourselves of of not just sugar being the problem. There's four deadly white poisons according to Dr. Kevin Mackey. There's sugar, salt, refined starches, essentially sugar, and saturated fat. And when you think about these deadly white poisons, it's pretty much in ultra-processed food. So the reformulation strategy needs to be needs to be considerate of this fact, but it also needs to consider other things like the food matrix and what we're combining the different foods with as well as what we are replacing it with. So are we replacing those four white deadly poisons with nutrient-dense ingredients? I think packaged foods generally do not, despite what the health halos and the packaging says on the front of it. So this is why I feel like we all need to get smarter about how sugar ends up in our shopping baskets when we're completely unaware. And there could be some subtle signs of too much sugar in your diet. Now, the obvious signs are things like excess weight, waist-to-hip ratio, high fasting glucose levels if you get that checked by your doctor. But there are some other ones as well that you might not be aware of. Chronic sinus problems and allergies. There are some observational studies in humans that suggest that a healthier eating pattern, i.e., one that has higher food diversity, a lot more plant protein intake, higher intake of healthier foods, fruits and vegetables and complex carbohydrates, and lower intakes of sugar and fast food are associated with improved outcomes of things like asthma, atopic dermatitis and allergic rhinitis. So these are all conditions related to our immune system and allergies or atopy. So I mean, it's not something that I don't I would have recognised while practicing as an early general practitioner 10 years ago, but now, whenever I think of anyone with rhinitis or allergies or what we call perennial rhinitis, so people who have constant running noses, this is something that we need to address with diet. It could be hidden sources of sugar that's sneaking into our foods. Another subtle sign, cravings and dips. There was a recent study published in Nature Metabolism using the Zoe Predict One cohort, and they showed that post-meal glucose dips are associated with raised appetite and energy intake. So people who experience these big blood sugar dips after eating, and you feel hungry and hungry. Everyone's had this sort of experience where you've had a big meal, usually a big carbohydrate meal, and then you feel like you're never going to be able to eat again. And then all of a sudden, a couple of hours later, you feel like you want some dessert. Well, it's because your body has responded to that high glucose level by pumping out insulin. There is an overshoot of insulin that drives your blood sugar level lower than when it was originally. And in that trough where your blood sugar is low, you feel hungry because your body, again, from an evolutionary point of view, has adapted to ensure that your blood sugar is steady and stable. And if it dips low, you've got to go out and eat something and it will tell you and send you signals to your brain to go and get some food. And that's why you tend to eat more energy in the form of calories during the day when you are having these big spikes up and down, up and down compared to those who have a steadier level of sugar in their blood or referred to as little dippers, those whose responses are smaller. Poor sleep and fatigue. There was a cross-sectional study of 395 adults among students of a university of medical sciences and they found that poor sleep quality was correlated with high consumption of sugar-sweetened beverages. We're going to get to what those are in a second. So short sleepers, so under six hours per day, had a high consumption of these sugary beverages compared to those who had more than eight hours of sleep. So there is a suggestion that hyperglycemia as caused by some of these sugar-sweetened beverages is something that can disrupt your sleep cycle. And there is some mechanistic evidence for that as well. When you are having a big meal, it can inhibit the hormone melatonin that is used to induce sleep. It has a whole bunch of other uses as well in the brain and the body. And when you have high amounts of sugar in your bloodstream, this could be interfering with that mechanism that affects your sleep quality. So poor sleep and fatigue, is it sugar consumption? Is it a myriad of all these different things? Something that I'm looking out for, you know, whenever someone is talking to me about their sleep and fatigue. Are they having too much sugar in their diet? Is this a contributing factor? There are some also some studies that link high sugar intake with a high risk of depression and anxiety. Now, there might be a reverse causal effect here, as we'll talk about in a second what that actually means. But I'm personally of the belief that when you consume too much sugar, it affects your gut. That excess sugar can reduce microbial diversity and promote gut inflammation. This can all have a knock-on effect on things like mood and your risk of anxiety and depression, as well as other mental health conditions, as well as a whole diversity of other conditions just from impacting your gut adversely. So if you're tired or sleeping poorly or someone you know might have these subtle signs of sugar excess consumption, really recognise whether your sugar intake could be playing a bigger role than you think. Now, I should state here that the strongest and most consistent evidence links high sugar intake, particularly from sugar-sweetened beverages, with weight gain, obesity, type two diabetes, coronary heart disease, and depression. Evidence for cancer is emerging, but it remains weaker and it's less certain, although I do strongly recommend people go on low-sugar diets as a cancer preventive strategy, as well as something that could be useful during cancer treatment as well. It's something that we've spoken to many different oncologists about on the podcast. I also strongly believe that there is an impact on neurodegenerative disease as well from high sugar consumption, diseases like Alzheimer's, dementia. So if you want to get serious about these conditions, we really need to get serious about sugar. So why is sugar so harmful? What is the mechanistic evidence that links sugar with all these different conditions? There's, you know, what I've described so far are associations. It doesn't necessarily mean that sugar is causing it, although that is my belief. And the reason why it's my belief is because we have observational evidence, we have cohort studies, and we do have mechanistic explanations as to why sugar is causing some of these issues. Excess sugar affects health through many indirect and direct biological pathways. Number one is the burden on our liver. So our small intestine normally acts as a shield, converting a lot of the sugars that we eat in refined starches and fructose, and it goes into glucose, the simplest sugar, and organic acids before it reaches the liver. But when your intake is really high, that system becomes overwhelmed. It can't deal with this conversion. So that excess sugar spills over into the liver where it's usually processed in the small intestine, it spills over into the liver and the liver's got the sugar and it doesn't know what to do with it. So it drives something called de novo lipogenesis. It needs to do something with the sugar, it can't just hang around in the liver. So it basically creates new fat as a storage molecule. It's like, okay, I've got this sugar, I'm going to create fat and then I'm going to pump it out to the body where it can be stored somewhere because I can't I can't keep it's like hot potato with the with the sugars. They can't keep hold of these sugars. And this leads to fat build up in not only the body, but at a certain level within the liver itself. Suddenly, it gets to a point where over time this excess sugar can't be stored outside in the body as efficiently anymore and the liver just has to keep on to the liver fat that it is created as a result of having this excess sugar in the body. It overstimulates lipogenic genes, worsening things like insulin resistance as well. And so it's this cascade of issues as a result of prolonged, this doesn't happen overnight, this is a prolonged process of excess sugar consumption that leads to higher fat in the liver, higher fat in the body, and ultimately insulin resistance, which is the precursor to pre-diabetes and type two diabetes. Fructose metabolism, and I've said the word fructose here, fructose is a type of natural sugar that you find in fruits, but it's also something that you find commonly added to ultra-processed foods, and we're just talking about the latter here, the the added sugar in ultra-processed foods and and confectionery and all the rest of it. This metabolism also lowers something called intracellular phosphate. So it requires a phosphate for for this whole process of of breaking down these sugars. And the byproduct of that is something called uric acid. And uric acid when it gets high, it triggers oxidative stress and further liver injury as well. So you have this myriad of different things that occur as a result of excess sugar consumption over time. So I'm going to summarise that. You get excess sugar, it's usually sorted out in the digestive system in the small intestine, that spills over into the liver, the liver can't keep hold of the excess sugar, so it creates fat, that fat goes around the body into the adipose tissue, into fat around organs, and then all of a sudden, it can't do this anymore, so it holds onto the fat, and then that whole process of breaking down these sugars leads to high amounts of uric acid, and then you get this high fat, insulin resistance, and then eventually type two diabetes. Type two diabetes is a very late phenomena after so many things have had to go wrong up to that point, which is why I think we need to again, when we think about type two diabetes, it's a it's something that we diagnose very late in the stage and we should be thinking about insulin resistance and high amounts of insulin production as a precursor to type two diabetes. This is a very late stage type two diabetes and insulin excess and insulin resistance is something that we should be measuring far, far earlier and acting on at that point because by that time we've actually diagnosed type two diabetes, the game is almost up. Not to say it can't be reversed or better managed, but we've lost the opportunity to intervene a lot, lot earlier. So that's the impact on the liver. Number two, the gut microbiota and barrier function. So I mentioned it earlier, but we're going to a little bit more detail here. Excess sugar saturates the absorption into the small intestine, spills over into the large intestine as well. So not only have you got spill over into the liver, you've got spill over into the large intestine where it shouldn't really be dealing with sugar at that point. Your large intestine is usually dealing with other metabolites and sugar shouldn't really be getting to the large intestine. But this is where your microbes that are there and ready and willing to start fermenting whatever food comes in, this is where they adapt by altering their gene expression and species balance. So suddenly, when you've got a predominance of sugar in the large intestine, it changes the map of your different microbes, it changes the population and reduces protective short-chain fatty acid production and promotes pro-inflammatory bacteria like Prevotella. And with this changing dynamic of microbes that are more likely to create inflammation rather than the short-chain fatty acids, the gut barrier gets weaker, it lets bacterial toxins in like lipopolysaccharide. If you remember the podcast that I did on intestinal barrier dysfunction and leaky gut or intestinal hyperpermeability, you'll realise what happens after that little bacterial toxin like lipopolysaccharide slips into the bloodstream. It activates your immune system. And this is the third mechanism where sugar is likely to have a detrimental impact. It creates inflammation and immune dysfunction. So once those toxins have found them themselves outside of the large intestine and got into the bloodstream, they're in circulation, they flip on the immune alarms, like toll-like receptor 4 and downstream inflammatory signaling pathways like NF-kappa B and JAK2 and all these names that you don't need to know. And what they do collectively is ramp up pro-inflammatory cytokines. It's like the siren's gone off, it's Pearl Harbor style response, it's sort of very, very destructive picture. And of course, if you're having a small amount of sugar, you're not really going to be seeing this. But it's excessive amounts of sugar over time that results in this background level of chronic inflammation that can drive conditions like obesity, type two diabetes and autoimmune disorders as well. So again, you're just getting this big inflammatory picture with prolonged excess sugar consumption. Number four is something that I think we talk about from the perspective of aesthetics, dental cavities, oral health, but actually, if you've listened to any of my podcasts with holistic dentists like Dr. Victoria Sampson, you'll realise that it's creating localized inflammation that translates into systemic inflammation. So localized being just in the mouth, systemic being in the bloodstream and then coursing around the body, which may be why we see things like a greater risk of dementia and a greater risk of heart disease with people who have local gum inflammation, gingivitis, periodontal disease, because of excess consumption of sugar that leads to the caries, that leads to the the cavities, that leads to the inflammation that leaks straight into the bloodstream. It's a very highly vascular picture, our mouths. We've got loads and loads of blood vessels here. And so if there is inflammation there that is really, really acute, that's going to seep into the bloodstream and that could lead to downstream destructive effects in organs and and places like our heart and our brain as well. So oral health is a real real big reason, I believe, as to why sugar has destructive effects as well. And lastly, and of course, there are many other mechanisms here, but we're just going to keep it brief, hormonal and appetite regulation dysfunction. So in the short term, sugars like sucrose and glucose and fructose, they reduce hunger by raising your blood glucose and stimulating the satiety hormone, GLP-1. But this effect is short-lived. And with high amounts of sugars, especially in liquid form, that blood sugar can drop back down quickly, which triggers hunger again. So you have this kind of on-off cycle of like hungry, I'm I satisfy that hunger, but because I've satisfied it almost too much and too quickly, I get a big drop in blood sugar that leads to appetite and overconsumption of sugars. And that's why I believe not only sugar in itself, which is highly calorific and we can easily consume in the in the form of ultra-processed food is damaging, but it also might lead to a cycle of overconsuming as a result of these constant fluctuations in our appetite. And then there's the idea that high blood sugar, which leads to advanced glycation end products, can accelerate ageing. These are essentially the internal rusting of our body because of high blood sugar that leads to the blood to be stickier and these proteins they bump into each other, it causes local inflammation and that can bump into other places like our arterial walls. I mean, there's a whole picture of advanced glycation end products that I want people to have whenever you're consuming something that's really, really sugary like a diet cola, like a regular coke or and you know, it's not going to be the one-off, it's going to be the persistent consumption of these sugars. This is something I want to really drum home into people's minds. It's the persistent consumption of excess sugars which is the issue, not the one-off sugar consumption. If you're having dessert once a week or once every two weeks, I don't believe that you're putting yourself at the same risk as someone who is having lots of sugar at every meal time. But many of us are overconsuming sugar and we are completely unaware of it. And there is this other question as to whether sugar is addictive. Is sugar truly addictive? I think it's a complex question. So the case for sugar being addictive, on the one side, in animal studies, rats given lots of sugar, they show the same behaviours that we see with drugs. They they binge, they they crave more, and when it's taken away, they show signs of withdrawal. And in people, brain scans, so people that have been put in these fMRIs, they show heightened activity in areas linked to pleasure and reward after that sugar consumption. And everyone recognises that you get like this little burst of reward when you have something sugary, something delicious, like a croissant from a new favourite bakery, that sort of thing. And people describe cravings and withdrawal-like symptoms and and tolerance, i.e., the the need to have more of the same product or or ingredient to get the same effect, which looks a lot like how tolerance works in addiction, obviously to a far lesser severity and degree. That being said, strong evidence in humans for sugar addiction is really lacking. When people cut back on sugar, the withdrawal effects are mild, to put it lightly, compared to drugs like nicotine or opioids. There isn't a dangerous physical dependence. So even though you might have some withdrawal symptoms like headache, fatigue, a mood disturbance, it's nowhere near the same as if you're coming off nicotine or opioids. A lot of sugar cravings can be tied to things like stress, mood, habits, rather than the brain literally being hijacked in the same way as hard drugs. And most people can cut back with gradual diet changes and support without needing medication to come off sugar, which suggests that sugar overconsumption is a serious health challenge, but I don't think we can meet the same strict definition of an addiction. I think there is a grade of addiction and for sugar, it's definitely less than hard drugs, obviously. So is it addictive? I would say for some people, particularly those with emotional eating patterns or high stress in their life, it can feel very, very close to that. But for others, it's more about environment. It's more about ultra-processed foods engineered to be hyper-palatable and always available and marketed heavily. I think in the in the with the backdrop of that, you can understand why people feel that they're addicted to sugar, but it's not the same addiction as we see with other substances. So I prefer to frame sugar as a habit-forming substance. And for many, cutting down reduces cravings within a couple of weeks. But for some, the urge is a lot stronger and I think we should acknowledge that as well. Let's also get some definitions clear about natural and added sugars. Perhaps I should have talked about this at the start, but anyway, we're here now. So when we talk about sugars in the diet, there are a few different categories that people should be aware of. Added sugar, for those of you watching on YouTube, I'm holding up a glass bowl of sugar cubes. So this is refined white cane sugar. But when I talk about added sugar, I'm talking about any type of added sugar in a syrup, whether it's agave, whether it's honey, it's put into foods by manufacturers or at home to have an effect, whether that is for baking, whether it's for browning, whether it's for taste, it's utilized for a for a purpose and it's added in its refined form, whatever that might be. It could be spooning sugar into your coffee, baking in a cake, high fructose corn syrup in a fizzy drink. This is what we mean by added sugar. Free sugars, these are added sugars plus the sugars that naturally occur in foods like honey and syrups, fruit juices and concentrates. These are free sugars that have been liberated from their natural structure, which is surrounded by things like fibre and polyphenols. So if you imagine a fruit juice, that has the natural sugars from the juice, the apple, let's say, which will be fructose, but it's freed. It's been made essentially to act in the same way as added sugar in the form of these teaspoons, these cubes of white sugar that I've got in front of me here. So those are pretty much equivocal in my mind. Free sugars in fruit juices and the added sugars in fizzy drinks. Intrinsic or natural sugars, these are the sugars that are naturally present in the whole food, like the apple, for example, or vegetables or milk. And because they come wrapped in fibre with water and antioxidants, vitamins, minerals, they're digested a lot slower. These don't appear to have the same negative health effects as fruit juices and added sugars. They might even support gut and metabolic health as well because of the fact they come wrapped with all these other additional health-promoting ingredients like fibre. And when you consume an orange, yes, it provides the natural sugar in the form of fructose in the case of an orange or an apple, but it also comes alongside vitamin C, fibre, and phytochemicals, whereas that is completely different to the glass of orange juice, which delivers mostly free sugar without the fibre. So in terms of the nomenclature, we need to just get clear the difference between added sugar and free sugars that you find in ultra-processed foods and juices versus the intrinsic sugar that you might find in an orange, an apple, a banana. And even though, if I had an apple in my hand here, this might have the same amount of sugar as in a candy bar, the impact on your body metabolically is going to be completely different. And it is not scientific to compare them based on their sugar content alone when you're talking about a completely different structured food compared to an ultra-processed product or a juice or whatever it might be, in an added sugar context. So I wouldn't equate whole fruits and vegetables with their sugar content to a manufactured food. It has completely different biochemical effects. And when you look at the evidence for eating fruits and vegetables, it's generally all positive. I would say it's 100% positive whenever you look at these studies. I've never come across a study that states fruits in the diet are detrimental, whereas the equivalent amount of added or free sugars are detrimental even if the total sugar consumption is the same. So the next time someone is trying to sell you a natural sweetener like honey or agave or apple puree or something from fruit concentrate, you'll know that these sweeteners, like coconut sugar, are, even though they're marketed as healthier alternatives to white sugar, their benefits are limited if not negligible. It has the same biochemical effect as the refined white sugar. So don't make that mistake and don't be duped into anyone selling you a natural sugar that's better for you. The best health advice remains to limit all added and free sugars regardless of the source and consume your sugars from whole fruits. Now, as I say that, you're probably thinking, well, I've heard that I shouldn't be having tropical fruits. I shouldn't be having mango or pineapple or banana because these are bred to have high amounts of sugar in them and they taste a lot sweeter and therefore they'll have a lot more fructose in. And whilst they are higher in sugar, they also contain fibre, vitamins and polyphenols. And there isn't any evidence that these non-tropical fruits are better for health than tropical fruits. There is a recent systematic review that suggested that different sources of fruit, including tropical fruits and dried fruits, are associated with comparable heart disease risk reduction as that of vegetables. And the authors suggested that public health guidance to limit intake of certain fruit sources because of concerns related to the contribution to sugars may have unintended harm in preventing people from actually meeting fruit and vegetable targets for heart disease risk reduction. So my perspective is, if you enjoy eating some of these fruits like mango and pineapple and bananas, I wouldn't steer clear of them. If you find using your own self-experimentation with a glucose monitor that these fruits tend to spike your sugar and you're uncomfortable with that, I get it. Then perhaps you might want to limit those and stick to the lower sugar fruits, things like berries that I'm a big fan of. And I think universally across the board, most people regardless of their dietary preference are fine with, unless I find out that berries suddenly have lectins in or something like that. But I'm pretty sure that's not the case. I I personally don't have an issue with them, but if you prefer to avoid tropical fruits because of the potential high sugar consumption, then that's totally fine as well. But please don't limit your fruit and vegetable consumption as out of concern because of those sugars in those fruits because they are, according to the evidence, pretty good for us. The lower sugar options that you can consider are things like berries, kiwi, citrus obviously, rhubarb, although that's very bitter, avocado, don't forget avocado is a is a fruit. Instead of worrying about tropical fruits, I would worry about liquid sugar. Liquid sugar is so much worse for us. There is a higher risk of serious health problems with those who regularly drink sugar-sweetened beverages, a high risk of ischemic stroke, heart failure, atrial fibrillation, abdominal aortic aneurysms. Sugar-sweetened beverages, also referred to as SSBs, are particularly harmful because they deliver large amounts of rapidly absorbable free sugars, especially fructose, in liquid form. And just like I was saying before, it bypasses the satiety and metabolic buffering provided by the the food matrix of whole fruits. It bypasses the capacity of your small intestine to break down that fructose into glucose and the organic acid and so it goes to your liver where it gets overwhelmed and does all those different things that I mentioned earlier. Sugar-sweetened beverages promote excess caloric intake due to this incomplete compensation for the liquid calories, leading to weight gain and high amounts of fat. And you can take in a ton of extra calories without realizing it. Anyone's had this, anyone who's had a can of of fizzy drinks will realize, you know, you've had three or 400 calories without realizing it at all. That's an entire hour's gym workout. And you often feel hungry again quite soon afterwards as well. There was a really cool study published about 20 years ago in Nature that painted a really good example of just how the sugar form affects our appetite. So they studied 15 healthy young adults and it was a crossover trial. So they gave them both these interventions and they crossed them over and then repeated the study. And the two interventions they had were four weeks of around 250 mils of soda, sugary soda per day. So that's about two-thirds of a typical can of soda per day versus sugar in solid form. They gave them the same number of calories in jelly beans. They had jelly beans, super sugary, and they had super sugary soda. And they crossed them over. So they gave them four weeks of this, wash out period and they crossed them over and they gave the same group of people the different sugary product. And what they found is that the solid sugar group, the jelly bean group as I'm referring to it now, they basically compensated this excess sugar intake with a reduction in their daily energy intake from non-supplemented sources. So basically what they did is that they naturally realized that they were overconsuming calories in the amount of sugar and so they reduced their overall consumption of food. In comparison, the soda group didn't have this realization and they actually increased their energy intake by 17%. That's over four weeks. An increase of 17% of your calories every single day over four weeks just after having 250 mils of sugary soda every single day is pretty big. And so what they found is that whilst there wasn't a difference in their body weight or BMI at the end of this period, the increase in consumption of calories over time is something that could put them at risk of things like obesity and fat around their body. And so because these beverages are less filling than the solid form with the same number of calories, you tend to eat more later on and this can add up to higher overall energy intake over weeks and months and years and that's closely linked to other health risks as a result of the weight gain as well. You could read from this study, okay, fine, I'm not going to drink soda, but I'm going to eat jelly beans. I think the overarching advice is to cut the sugar entirely, but it just shows you the differences in behaviour when the form of the sugar has been changed. It's the same number of calories, it's the same type of sugar, but one is in bean form and one is in liquid form and the liquid form is leading to you being a lot hungrier and overconsuming energy over the course of a day. This is why, another reason why it's so detrimental. I used to be a sugar addict myself and so I've had a lot of these conundrums. And then I made the swap to healthier products like granola bars and flapjacks until I realized I was simply consuming sugar in a different form, honey, syrups, caramel, etc. So here are some of the strategies that I've used personally and I've looked at from the research that can help you cut down on your sugar consumption every single day. The first thing is to swap your breakfast. Morning is where a lot of hidden sugar sneaks in. Cereal, jam on toast, juice, it all adds up super, super fast and it puts you on what I describe as a sugar rollercoaster. You get that rush and then the dip and then the craving for more, usually around mid-morning and that's when we get biscuits and all the rest of it. So you really haven't set yourself up for a nice steady sugar levels throughout the day. Instead, I suggest building a breakfast with protein and fibre. Eggs, beans, last night's leftovers, it keeps your energy and sugar levels steady. When I started doing this, I lost that craving for that mid-morning snack, that biscuit or the jelly beans at the nurses station, the Ferrero Rocher that you can't really seem to go past without reaching for, I lost that craving. And when I started eating a lot more of that in the morning, that high fibre, low sugar option that we have many options on the Doctor's Kitchen app, my focus levels and my energy levels just were super, super steady. And if you really want something sweetish, a Greek yoghurt bowl, overnight oats are also good. Just make sure that you add lots of protein and fibre-rich ingredients, hemp seeds, flax, mixed nuts, nut butter, berries. We've got loads on the Doctor's Kitchen app as well. And even if you need a little bit of sugar in the form of honey, particularly as you're transitioning to a low sugar diet, when you use that syrup or honey, you're in control of exactly how much you're putting in. You're in control of that sweetness and you can start to reduce it gradually and letting fruit and spices bring the sweetness. And I highly recommend you use sweet spices. Cinnamon is super, super sweet when you taste it. Clove, allspice, these are wonderful additions to your morning if you need that sweet hit in the morning and let fruit do the talking with blackberries, blueberries, and even things like pear in the whole form. You can find my favourite breakfast recipes on the Doctor's Kitchen app. You'll feel fuller for longer, you'll cut out at least two to three teaspoons of sugar without even noticing it. And there's a really famous graphic of a typical breakfast of cereal, skimmed milk, juice and jam and that hits your added sugar consumption for 24 hours for an adult within the first meal of the day. And so, you know, when you see that picture, you recognise this is a typical breakfast that many people across the UK are consuming and in hospital as well. That's a typical hospital breakfast that I've seen many, many times given whilst on a ward round and it always irks me now when I see it. So, yeah, this is the sort of information we need to be giving out as much as possible. Think about your breakfast swaps as a means to reduce those hidden sugars. Number two, goes without saying, but rethink your drinks. Drinks are the biggest sugar trap in my view and it's not just fizzy drinks or sodas, it's bottled smoothies, it's fruit juice, it's iced coffee, energy drinks, chai lattes, sweetened oat milk, even that lovely coffee store that is doing artisanal barista style coffee, unfortunately they're using a lot of syrups whenever you're getting flavoured coffees and a single glass can contain more free sugars than a dessert, especially if it's made with added syrups and concentrates. And because it's liquid, your body doesn't register it in the same way, you don't feel full, it's easy to take in lots of sugar in that moment and, as we've seen by some of those interesting studies published in Nature, you will overconsume calories as a result of this appetite increase over the day as well without realizing it. The real shift comes when you start enjoying homemade drinks that are naturally less sweet, like water, iced tea, iced coffees, making sparkling waters with berries or slices of lemon. My go-tos are hibiscus tea that I sweeten with clove and nothing else. You can add a little bit of maple syrup if you want, but I've got to the point now where I enjoy the flavour and the aroma and the floral notes of that hibiscus tea on its own. Homemade iced tea with berries and slices of lemon, black coffee with ice or, I mean it's summer right now, so that's why I'm having black coffee over ice or cold brew. A homemade smoothie that you can actually add a little bit of greens to. I've even started experimenting with peas in the in the smoothie in addition to some of the berries. You won't realize that there's peas in it, but it's adding extra protein and fibre and you're sneaking in some greens as well. You can use whole Greek yoghurt as well for that extra protein hit and some of those extra benefits of the of the dairy. And there are lots of low sugar drinks on the Doctor's Kitchen app that you can experiment with as well from matcha to to some of those berry smoothies as well. That way you're in charge of the sugar and the ingredients, not a food manufacturer. Number three is a big one. Of course, I still crave sweet foods, but whenever I do, I try and pause and ask myself three things. And these are three questions I think you can ask yourself as well. Number one, am I hungry or bored? If I'm truly hungry, I'll try and have something with protein first. Greek yoghurt, handful of nuts. Other times, if I'm genuinely after something sweet, I'll reach for fruit, something that I can grab quickly like an apple or some berries, usually from the freezer as well. And I'll pair that with some dark chocolate, which is absolutely delicious. Or I'll have dates with peanut butter. That's usually my my go-to. Just asking myself whether I'm hungry or bored gives me the intention to eat with the the right mindset. The second thing is, I ask myself whether I'm just thirsty. Often, a big glass of water or herbal tea is all I need. Sometimes we confuse thirst signals for hunger signals and that's something to be aware of as well. And number three, this is a big one, is it about comfort? Am I tired? Am I stressed? I try and recognise that and build in other wins that make me feel good, like a quick walk or stretching or even phoning a friend. And there is evidence, strong evidence that people experiencing stress tend to consume more sugar, including sugar-sweetened beverages and foods that are high in added sugars as a form of comfort or self-soothing. There've been multiple cohort and cross-sectional studies, particularly those performed during the pandemic actually, that demonstrate when someone is undergoing psychological distress or negative affect or negative feelings, depression, it's associated with an increased intake of high sugar foods and drinks, a pattern often described as emotional eating or stress eating. And we see this comfort food effect observed across both animal and human models and it's associated with not only chronic stress, but also acute stress as well. It's, I mean it's in our language, it's in our lexicon. There's a reason why we call things soul food or comfort eating in and of itself. And mechanistically, what happens is when you consume palatable high sugar foods and beverages, it blunts the psychological stress response, such as cortisol reactivity, and it activates these brain reward pathways providing short-term relief from stress or negative mood states. So it is literally doing some comforting to your brain as well. And if you think about the record rates of anxiety and mental health conditions against the backdrop of cheap hyper-palatable food availability, it's no wonder we all eat too much. But again, we're not all the same. Some people react to high stress situations by developing a preference for these high-fat, sugary foods, whereas others might not or even lose their appetite leading to weight loss. So we're not all carbon copies of each other and our biology is incredibly unique. I'm also convinced that the reason why so many medics and people at work in clinical environments are addicted to sugar is because of the amount of stress that we undergo. I mean, during the pandemic, but also just during my time as a regular hospital doctor and GP, we're just constantly surrounded by sugary treats and I often overconsumed sugar because I was craving that bit of comfort, that little bit of release, that little bit of pleasure here. And recognising that in yourself, a lot of people don't. And the difference now is that I try and make sugar a mindful treat. So I I try and have my chocolate, undistracted, away from a screen, away from my phone, sat down or enjoying it with someone, rather than a mindless habit when I'm just mooching around the kitchen or bored at home in front of the TV. If you switch it from a mindless activity to a mindful activity, not only do I recognise whether I need that sweet treat or not, but I also tend to consume less as well because I'm a lot more engaged with what I'm eating. So make that high sugar treat an occasion with people, enjoy it socially, but not as a daily staple. And number four, creating your food environment. Most of the sugar decisions happen in the shop, not in the kitchen. So if something's in the house, particularly if it's me, if it's easy to reach for, especially when I'm tired or hungry, I'm going to be eating it. So the goal is to set up an environment that makes it a lot easier to eat whole foods first. The first thing I do whenever I'm at the shops is I check the label before I buy anything. A quick scan, particularly for those packaged and pre-made products is to look for hidden sugars. Remember the names that can show up and check those against the potential names, syrups, concentrates, fruit puree, it's all the same, it's all sugar. And then also look at the added sugar content per 100 grams. 5 grams or less per 100 grams is considered low sugar. Number two is I try and swap packaged foods for the whole versions as much as possible. So instead of granola that is commonly loaded with sugar, I just buy plain oats and then I add my own toppings. You can even make your own granola that we have on the Doctor's Kitchen app as well, where you can choose how much syrup you're actually consuming. And instead of bottled dressings, salad dressings, make a quick one at home with olive oil, lemon, herbs. It's so much easier, it's cheaper, and that way you're avoiding the hidden sugar that shows up time and time again in dressings. And obviously, rather than juice, I just pick up whole fruits. Instead of cookies, almonds and dark chocolate, you get the score. There are lots of processed food swaps that you can find on the Doctor's Kitchen app as well. And if all this sounds way too complicated, let virtual Dr. Rupy do it for you as well as our AI meal planner. You can plan your whole week of eating and generate a shopping list in just a few clicks on the Doctor's Kitchen app. Just try it for free and then if you just type in, okay, I've got three people I'm cooking for, I need it for lunch and dinner, it will generate and I need it for these days, four or five days, whatever, it will generate a shopping list immediately according to your preferences, according to your diaries. You can swap out things that you have and don't need and then it will give you your your tickable shopping list as well. So it makes it really, really simple for you. Go try that out. And number five, I wrote a whole book on this, Healthy High Protein. Adding more protein to every meal is what changes everything long term because it goes straight to the root cause of a lot of people's issues. If your meals aren't filling, you're going to keep craving something sweet. So instead of building your meals around carbohydrates, like a big bowl of rice or pasta, which is what a lot of people start with, instead, think about your clear source of protein, tofu, tempeh, fish, chicken, and then add extra plant protein like beans or lentils and lots of fibre from greens and colourful vegetables. It's really important to keep you satisfied and fuller for longer. And when I started adding more protein to my meals, and not only breakfast, but also lunch and dinner, cravings dissipated. So when you have a lot more protein in your diet, you will satisfy your need for consumption of food because it signals to your brain that you're having the most important macronutrient, which is protein. And a lot of us, actually, because of the way we exercise, because of our age, because of the menopause, actually require more protein than the recommendations that are set in the UK. And I'm a firm believer in choosing a higher protein amount and actually measuring your protein every single day to actually determine whether you're consuming enough protein. And luckily for you guys, on the progress tracker on the Doctor's Kitchen app, you can just take a snap of all your meals and it will calculate the protein that you're consuming. And then doing that as a challenge for four or five days will give you an idea as to whether you are under or over consuming protein. And hopefully that will give you more clarity as to whether you need to make some changes. Sugar as an isolated nutrient is not evil, but the way free sugars and added sugars have crept into nearly every corner of our food system has left many of us consuming far more than we realise. Cutting back doesn't mean never enjoying dessert again. I personally still have dessert all the time, not regularly every single week, but certainly like once or twice every single month. And I think it it's about being aware of hidden sugars, choosing whole foods more often, and giving your body the chance to thrive with steadier energy, better sleep for long-term health. And if you want to know some of my go-to breakfast recipes that are high in protein and high in fibre, we actually did a YouTube video that you can watch on the Doctor's Kitchen YouTube channel, which is all about my go-to breakfast recipes that you can prep ahead and eat on the go. You can find that on the Doctor's Kitchen YouTube channel right now.
