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Death By Cupcake

Happy Valentine’s Day! People who know me will say today’s health tip on the dangers of sugar is just typical, badgering innocent people on a holiday dedicated to love, romance, and dessert. Before we get started, let me pull out my two favorite passive-aggressive chestnuts: “I’m just looking out for your best interests” and “I only want to help.”

If instead of cupcakes or a five-pound box of chocolates you bought your dearest a bouquet of fresh flowers or a sparkling diamond bracelet, you’ll be more relaxed about reading this, possibly feeling a tiny bit smug and self-righteous.

For the rest of you: according to an article in last week’s journal Nature, you are poisoning your sweetheart.

Maybe you’ve already heard about this. Three researchers from different fields (a pediatric endocrinologist, a sociologist, and an expert in public health policy) are recommending that sugar be regulated like alcohol and tobacco. This means all sugars, and if you click through you’ll see the list of other names for sugar includes the much-marketed agave nectar as well as fruit juice concentrates, dextrose, honey, syrup, and on and on.

In fact an increasing number of illnesses are being linked to sugar. If we add up all sugar-related deaths, the number comes to a whopping 35 million deaths worldwide every year. This grim statistic occurs as a result of three sugar-triggered conditions that are developing at a record pace: metabolic syndrome (and its consequences–diabetes, high blood pressure, and heart disease), non-alcoholic fatty liver disease, and, less commonly, non-alcoholic steatohepatitis.

The US and its astonishing sweet tooth
An analysis of grocery records determined that back during the pioneer days, when sugar was a luxury, we ate about 15 pounds of it per year. But currently each and every American is downing 150 pounds annually, much of it tucked surreptitiously into processed and prepared foods including low-fat and zero trans fats foods. The 150-pounds-per-year figure, by the way, translates to a daily intake of just a bit more than 0.4 pounds of sugar, or 45 teaspoonfuls (dangerously close to one cup) every single day. Considering a can of soda alone contains 13 teaspoons of sugar, you can get to 45 pretty quickly.

The reason for the new alarm about sugar is not simply that it’s an “empty calorie,” completely devoid of nutritional merit, but that sugar is handled by your body in much the same way alcohol is (which makes sense since, if you remember, alcohol comes from sugar).

Both high fructose corn syrup and sucrose (table sugar) are equally destructive. Here’s what happens when you ingest them: after being absorbed through your intestines, the sugar passes through your liver. When your liver is overwhelmed by sugar, it converts sugar to fat molecules, which are then stored in liver cells themselves. This condition, called fatty liver, was once a relatively rare condition, generally seen in alcoholics prior to developing cirrhosis.

But now, so many non-drinkers and moderate drinkers are being diagnosed with fatty liver disease that most cases are called non-alcoholic fatty liver disease (NAFLD). Once considered a generally harmless condition, we now know that people with NAFLD are at increased risk for metabolic syndrome (more on this later) and the especially severe form of fatty liver called non-alcoholic steatohepatitis (NASH), which can lead to cirrhosis or liver cancer.

Over the past 20 years, the frequency of fatty liver has escalated, directly correlated to our escalating sugar consumption. A fatty liver triggers a change in liver metabolism, not only storing fat but producing more bad cholesterol (LDL) and less of the helpful form (HDL). Your fatty liver is a source of increased inflammation as well, inflammation that causes LDL cholesterol to deposit itself inside your arteries, a significant cause of both heart disease and high blood pressure.

Metabolic syndrome
The most common and dangerous consequence of excess sugar intake is not fatty liver, but rather metabolic syndrome (though most people with this condition have some degree of fatty liver as well). Faced with a daily onslaught of 45 teaspoonfuls of sugar, your pancreas–desperate to lower your blood sugar–pumps out insulin, a hormone that lowers blood sugar levels by driving sugar into cells, where it’s used for energy.

Ultimately this whole system of pancreas, insulin production, and sugar transport becomes fatigued. Your insulin production drops, your cells become increasingly resistant to insulin, your blood sugar begins to rise, and you develop diabetes. And all that excess insulin in your blood triggers the release of a brain chemical called leptin. At normal levels leptin is helpful, telling your brain that you’re no longer hungry so that you’ll stop eating.

But too much leptin is not useful because it causes the leptin molecule to stop working. You can’t tell when your hunger is appeased, so you keep eating and you get fatter. Too much leptin also increases inflammation, and you know where that leads.

I’m now seeing more patients with metabolic syndrome than ever before in my three decades of medical practice. It’s a significant concern because patients who develop metabolic syndrome have a very substantial risk of progressing to diabetes and heart disease.

By our current definition, metabolic syndrome is a combination of the following:

  • Abdominal obesity (for men greater than 40 inches, for women greater than 35 inches).
  • Elevated blood triglycerides (a blood fat).
  • Low HDL (the good cholesterol).
  • High blood pressure.
  • Elevated fasting blood sugar or abnormal glucose tolerance test.

You can reverse all of this yourself
If there’s a positive spin on the metabolic syndrome, NAFLD, and NASH, it’s they’re all reversible by healthful eating and regular exercise. A solid first step is to drastically cut back on sugar, but you’ve got to approach good health, changing your eating habits, and the care of your body with the same gung-ho enthusiasm of a born-again finding Jesus.

Work with one of our nutritionists (Marla Feingold or Seanna Tully) to understand how real foods can help you get well. Then start cooking for yourself.

At the same time, activate your expired health club membership, quit using your treadmill as a clothes hanger, or hire a personal fitness trainer.

Of course it’s a good idea to prevent this from happening in the first place. Which brings me full-circle back to Valentine’s Day and cupcakes/chocolates on the front seat of your car.

If you consider that metabolic syndrome, NAFLD, and NASH are our “new diseases,” that obesity levels are highest in recorded history, and that all this began with our unstoppable craving for sugar, you can appreciate why the researchers writing in Nature place sugar right up there with alcohol and tobacco, needing someone to step in and say “stop!

Be well,

David Edelberg, MD 

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10 Comments


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  1. bridgette minyard says:
    February 13, 2012 at 5:57 pm

    Thank you ! A MESSAGE I’VE BEEN
    WORKING TO KICK FOR ALMOST FIVE
    YEARS. FOR ALL OTHERS LIKE ME,
    DON’T GIVE UP THE FIGHT! OUR LIFE
    STYLE CHANGE!

  2. Kathleen Casey says:
    February 14, 2012 at 8:31 am

    Thank you for the helpful synthesis of the all confusing information about what sugar does to us. I have been taking a break from sugar (and grains) for a week now and, you are so right, it does take the enthusiasm of a born again! :) But I felt better in less than two days! Wow.

  3. Cherie says:
    February 14, 2012 at 8:46 am

    I am generally a healthy eater, but I have an addiction to “healthy” dark chocolate. I have been consuming more and more in the last year and noticing an increase in the amount of cellulite on my body. Research on the web explained how cellulite is formed, and the role the liver plays. Even after I understood this, I continued to eat dark chocolate without much moderation. This article was so inspirational to me that I no longer worry about having to self regulate. I’ve always known sugar was dangerous, but after reading this article, I no longer feel I have to “resist” sugar; healthy fear of it has finally become an ally for more effective self-preservation. As always, Dr. E, thanks to you and your whole team for everything you do every day to keep your community healthy.

  4. Norma Samame says:
    February 14, 2012 at 9:11 am

    Yes I agree, except for the comment about feeling smug about the diamond bracelet which represents slavery and inhumane work conditions in diamond mines owned by rapacious thugs out to destroy their native countries. Those who buy such things should feel less than smug-like.

  5. Addie says:
    February 14, 2012 at 9:23 am

    [Then start cooking for yourself.]
    To me this is key to avoiding sugar. The only way to control ingredients is to cook for yourself. There are several good sugar substitutes that help me with the craving. My downfall in the winter is hot chocolate. Stevia has nutritional value and tastes really good in hot chocolate. Unfortunately not all grocery stores sell pure powdered chocolate anymore. They’sell the processed instant kind loaded with you-know-what. So even if we cook for ourselves, we have to avoid processed, packaged stuff.

  6. Jackie says:
    February 14, 2012 at 11:35 am

    I was wondering what your position is on the value of coconut oil…I am reading a book on it by Dr. Bruce Fife and, well, it seems to good to be true…and, you know where that leads!

  7. Dr E says:
    February 14, 2012 at 2:34 pm

    Unfortunately most of the “positives” written about coconut oil come from sources that have a financial interest in the product. This is termed “flawed data.” Taking any of the so-called “good” oils, like coconut or flaxseed oil will help dry skin and hair. It’s also a good cooking oil and a nicely scented massage oil. The other purported benefits, like weight loss, fall into the realm of wishful thinking. I would hold off swigging coconut oil until unbiased clinical data starts appearing in medical journals

  8. Jeanine Bakker says:
    February 14, 2012 at 9:10 pm

    Thanks you for this article le. I’m an elementary teacher and today has been all about eating sweets. We need to find new ways of celebrating this day in our schools or the next generation of adults will continue linking sugar within love. I vote for a revival of poetry, back rubs, flowers and dark chocolate.

  9. Mery Krause says:
    February 15, 2012 at 10:44 am

    How did you know I was using my treadmill as a clothes hanger??? Are you a peeping Tom??? Great article for everyone, no matter how heathy you think you are. I’d bet a million bucks that you did not have a cupcake for Valentines Day……….

  10. Bonnie Gosdick says:
    February 15, 2012 at 4:29 pm

    Great article–has me thinking about how to cut sugar from my daily diet. I do eat healthy organic foods with tons of veggies and fruits. But I love those sugary desserts and wine. I will have to make some better choices. Thank you for keeping us informed. Bonnie