Why is sugar regarded as 'empty kilojoules'?

Unlike other foods, sugar supplies energy only, which is why it is often accused of providing 'empty kilojoules'. The underlying fear is that if you eat a lot of sugar, you may leave out more nutritious foods, to the extent that your diet may be deficient in nutrients such as minerals and vitamins. However, studies of nutrient intakes have shown that this is not necessarily the case. There is in fact no evidence that people who eat a lot of sugar are more likely to suffer from nutrient deficiencies than those who eat very little.

The explanation for this apparent contradiction lies in the composition of the diet as a whole. Generally speaking, sugar consumption rises with income (up to a point), therefore people whose diets contain relatively large amounts of sugar also tend to eat large amounts of a wide variety of other foods, so it is unlikely that they will suffer from nutrient deficiencies. Incidentally, it is important to realise that when referring to sugar consumption we are talking not so much about `sugar bowl' sugar as about that contained in processed foods, desserts, and so on - in other words, in the diet as a whole.

Another interesting point here is the apparent inverse relationship between sugar and fat in the diet - described by some authors as the 'Sugar:Fat See-Saw'. Recent studies have shown that in certain populations, people who eat less sugar tend to eat more fat and vice versa. What these studies also revealed was that those who ate more sugar but less fat were taking in more of other essential nutrients and fibre as well.

The conclusion that can be reached from all this is that there is no direct relationship between the amount of sugar you eat and the overall quality of your diet. Far more important is the composition of the diet as a whole. Obviously, excessive sugar intake should be avoided, but if you are aiming to improve the nutritional value of your diet it would

be better to examine what you eat in total and make all-round improvements, than to focus on the elimination of a single foodstuff such as sugar.

The 'pure, white and deadly' tag

In the past few decades there has been an alarming increase in the incidence of so-called Western diseases such as heart disease, cancer, diabetes, hypertension and certain gastro-intestinal disorders. In the search to find out why this was happening, attention naturally focused on diet, since this was one of the areas that had undergone remarkable changes. Amongst other things, one aspect of the average diet that had changed was sugar intake.

In the early days sugar was a rare commodity out of the price range of most people, but as it became increasingly available, it was eaten in greater quantities by more and more people. Recognition of this fact led to a series of investigations in which sugar intake was compared with the incidence of various diseases and in many cases, the relationship seemed obvious - hence the claim made in the 1970's that sugar was 'pure, white and deadly'. However, in drawing simple comparisons such as these it is both easy and tempting to ignore the many other factors that could influence the outcome. In the years that have elapsed since these claims were first made, a great deal of research has been done on the causes of these diseases and we are now better able to identify those to which sugar may genuinely be linked.

Sugar and diabetes

Diabetes (or more correctly, diabetes mellitus) is a very complex disorder and neither its causes nor its treatment are as yet fully understood. For many years it was believed that eating too much sugar caused diabetes, but this theory has now been discounted. The cause is not yet known, although it is accepted that obesity is a contributory factor. Recent years have seen a considerable shake-up of traditional views on the treatment of diabetes. Nowadays, the diet recommended for diabetics is high in complex carbohydrates and low in fat. Some experts believe that a small quantity of simple carbohydrate can also be included, provided the condition is well-controlled and the intake of fibre sufficiently high. This is however controversial and no diabetic should eat sugar without the go-ahead from his or her doctor and/or dietitian.

Sugar and heart disease

The subject of diet and heart disease continues to be controversial and although there seems to be little doubt that the amount and type of fat you eat is important in determining your risk of having a heart attack, no such link has been confirmed for sugar. However, a small proportion of people are particularly sensitive to carbohydrate - for them, eating large quantities of sugar can result in a higher level of fat in the blood so sufferers of this condition should reduce their sugar intake to a minimum. This is generally referred to as 'carbohydrate sensitivity', a term used to describe a condition where serum triglyceride levels are elevated and the insulin response to a sucrose load is accentuated. The condition can only be diagnosed by a doctor with the aid of certain blood tests.

Sugar and dental decay

There are several factors involved in the development of dental caries (tooth decay), including heredity, oral hygiene and of course, diet. The role played by diet is more complex than you might think - it is not only what you eat that's important, but also how you eat it. The adhesiveness (stickiness) or abrasiveness of specific foods is yet another factor.

It is common knowledge that sugar contributes to dental decay, but perhaps less well-known is the fact that this applies to all fermentable carbohydrates, including those that don't even taste sweet (such as sausage rolls or potato chips). Research has shown that perhaps the most important thing to consider in terms of diet and dental caries is how often you eat cariogenic (caries-producing) foods such as those containing sugar. To help prevent caries, these foods should be eaten with meals rather than in between. This is because tooth decay is caused by acid-producing bacteria present in the mouth. Each time cariogenic foods are eaten, acid is produced, so it follows that the more often you eat these foods, the greater the likelihood of caries developing. In addition, try to choose foods that are easily chewed and swallowed - the longer the food stays in your mouth, the more likely it is to cause trouble. Boiled sweets that are sucked slowly, or foods that leave bits stuck to the teeth (such as biscuits or dried fruit) are particularly cariogenic.

Interestingly, some foods act as 'buffers' and counteract the harmful effects of other foods on the teeth. These include nuts and certain cheeses (for example, mature Cheddar, Gouda, blue Brie and Mozzarella). Such foods cause less acid to be produced than does cariogenic food. So the long-standing tradition of following a sugary dessert with cheese is highly recommended, at least as regards dental health!

How fibre affects the body continue...

Appendicitis

Appendicitis is inflammation of the appendix, the small blind-ended tube at the beginning of the large bowel. Although the underlying causes of appendicitis are not clearly understood, there is evidence that regular intake of fibre may prevent the development of the disease.

Hiatus hernia, varicose veins and piles

Many doctors believe that abdominal straining due to constipation encourages the development of conditions such as hiatus hernia (where the top of the stomach is pushed upwards, out of the abdomen and into the thoracic cavity), varicose veins and haemorrhoids (piles). It is often necessary to have surgical treatment for these conditions. Treating constipation with high fibre diets and, as a result, avoiding straining, may prevent these problems and may even reduce the need for more drastic treatment in some cases.

Coronary heart disease (CHD)

Coronary heart disease is the most common cause of death in affluent Western countries (see page 151). A large number of factors influence the development of the disease, of which raised blood cholesterol levels, high blood pressure and hypercoagulability (the tendency of the blood to clot too easily) are probably the most important.

Researchers believe that high-fibre, low fat diets protect against CHD by lowering blood cholesterol and probably also by decreasing blood pressure and the clotting ability of blood. It is especially the water soluble or gel-forming dietary fibres - found in oats, legumes and some fruit and vegetables - which help to lower cholesterol levels. While it should be borne in mind that diet is but one of the many factors which influence the development of CHD, it is also one of the controllable ones.

Diabetes mellitus

There are two forms of diabetes mellitus, a disease characterised by the excretion of glucose (sugar) in the urine (see What is diabetes? on page 175). Both forms are today treated with a high carbohydrate, high fibre, low fat diet. Fibre in the diet normalizes the body's response to dietary carbohydrate (glucose tolerance). A regular high intake of dietary fibre also improves insulin function by increasing the sensitivity of muscle and fat cells to the hormone.

Gallstones

The body manufactures these crystalline substances when the amount of cholesterol in the bile is so high that the bile salts cannot keep it in solution. The stones may block bile ducts between the liver and gall bladder or between the gall bladder and small intestine, resulting in severe pain and even jaundice. As in the case of other diseases of affluence, a number of factors may contribute to the development of gallstones. It has however been shown that high fibre intakes stimulate the production of those bile salts which keep cholesterol in solution, thus decreasing the risk of gallstone formation. Populations who follow high fibre diets have a significantly lower risk of the disease than those on the average refined Western diet.

To what degree is fibre involved?

Although research has proved that dietary fibre has a positive effect on body functions in general, the degree to which it is involved in the risk and development of the above diseases is still unclear. Studies are hampered by the fact that a variety of causes play some role and also because high-fibre diets differ in more than one respect from low-fibre ones. For example, they usually have a lower fat content - especially saturated fatty acids from food of animal origin - and are higher in vitamins and minerals. These factors could add to the beneficial effects seen in people who eat a high-fibre diet.

What is diabetes?

Diabetes is a disorder in which the pancreas cannot produce enough insulin, a hormone which prevents blood sugar levels from rising too high, or in which the insulin that has been produced does not function properly. It does this by helping body cells to take up glucose - either to metabolise to energy or to store as glycogen or fat.

If an individual manufactures too little insulin, there are two possible forms of treatment: The young, more severely affected diabetic can only survive if given daily injections of insulin for the rest of his or her life. However, if diabetes develops at a later age, treatment with pills is usually effective. These pills are not insulin; they are essentially compounds which give the pancreas the necessary stimulus to produce more insulin to cope with the carbohydrate (sugars and starches) which the individual eats. Because sugar causes a dramatic rise in blood sugar levels, diabetics should obviously avoid it in their diets; indeed, they should avoid all unnecessary food in general if they are overweight, as not only is the insulin requirement related to food intake, but excess weight has an aggravating effect on the condition. Obese diabetics who develop the disease in later life can often be treated by diet alone.

A low fat, high fibre intake - which 'dilutes' the contents of the digestive tract - slows down the passage of glucose into the blood stream and hence the elevation of the blood sugar is less dramatic.

Traditional Foods are the Healthiest

The diverse foods of the world's regions also serve another purpose—besides offering us biodiversity and wonderful flavors, researchers now believe that a diet based on traditional, indigenous foods is often healthier for us. For instance, East Africa's Masai people are cattle herding pastoralists, with a diet that's primarily based on milk and meat, meaning 66 percent of their calories typically come from fat, primarily saturated fats. To put that into context, most North American dietitians recommend no more than 30 percent of our daily calories come from fats. Timothy Johns, a Canadian ethnobotanist at McGill University, studied the Masai diet and lifestyle and discovered they also ate a vatiety of wild, indigenous plants that are high in antioxidants and other properties that tend to reduce cholesterol levels. His research concluded that balancing the diet with indigenous plant foods is one of the main reasons the Masai people typically have no health problems related to the consumption of so much saturated fat.

The people of the Tohono O'odham tribe of southern Arizona are trying to bring back their traditional wild foods to help address their soaring heath problems. Prior to 1960 diabetes was unknown on the Tohono O'odham reservation. Since then, the tribe began to adopt the typical North American diet with an emphasis on saturated animal fats, processed foods, and a lot of sugar. By 2004 the tribe had one of the highest rates of adult-onset Type II diabetes in the world, with 50 percent of all tribal adults diagnosed, and even some children being diagnosed with diet-related diabetes.

Researchers eventually concluded that the tribe's traditional, indigenous diet of wild foods—such as tepary beans, mesquite beans, cholla (cactus) buds, and chia seeds— helps regulate blood sugar and can actually reduce the incidence and impact of diabetes. So with the help of a USDA food security grant, the Tohono O'odham Community Association began sponsoring outings in the Sonoran Desert to collect the tribe's wild foods. They also distributed more than 1,000 packets of traditional seeds. Now gardeners on the reservation are restoring the traditional foods as well as the wild ones. Ultimately, it is hoped that the tribe will dedicate more of its 10,000 acres of cultivated land to traditional food crops, reducing the amount of land that is now used for cash crops such as cotton and hay.

When the tribe moved away from its indigenous diet, it wasn't just the people's health that suffered. They also experienced a decline in those cultural practices that were associated with traditional foods. With this renewed commitment to eating wild foods, the youth are once again learning the customs surrounding harvest. The tribe even brought back the rain dance ceremony, which had not been performed for thirty-five years. Now when the tribal mem

bers dance beside the new crops of traditional foods, asking or rain to sustain them, there is renewed hope for their harvest as well as their tribe.

Wendell Berry, the well-known Kentucky-based author who often writes about the ethic of contemporary agriculture landscape, laments the loss of so much agrarian knowledge—wisdom that took generations of family farmers to acquire. Imagine the fate of the Tohono O'odham people if the knowledge of traditional foods and customs had died off with the tribal elders?

Slow Food Picks up the Pace

The Slow Food movement recently found momentum at a conference, Terra Madre, held in Italy early in 2005. There 5,000 farmers from 130 countries met to discuss the future of food and how the individual farmer—and the local delicacies they produce—can survive amid the commercialization that is so dishonestly promoted by governments and multinational agribusiness.

This gathering was in part a response to meetings of the WTO, the World Trade Organization, and other organizations that seek to determine how foods are produced and traded. It was attended by a diverse cross section of international food producers, including rice farmers from Benin, beekeepers from Azerbaijan, Maori potato producers from New Zealand, and Vermont cheese makers from the U.S. It served as a powerful reminder that determined farmers can survive amid the globalization of today's marketplace. And by banding together, these small Slow Food producers are succeeding in raising the profile of the movement and strengthening their markets. Most importantly, they are finding a collective voice, having realized that individual voices are all too often silenced by the power of international corporations and the political parties they support.

But there is strength in numbers. As one conference attendee said, "It's so good to know we're not alone."