Week 16: Carbohydrates - Sweet and Vicious

What's in a name? That which we call a rose by any other name would smell as sweet.

[In]arguably the most famous line in the most famous romantic play by the most famous playwright anywhere - William Shakespeare, those words were penned in 1595, exactly 350 years before the end of World War II. During the 70 years that have followed since war’s end – years marked by a period of technological and economic advancement unmatched in human history – our consumption of sugar has also skyrocketed, surging by over 88 lbs. per person per year, to approximately 150-170 lbs./year/capita (or 200 grams/day) today in the US, according to the USDA (more conservative estimates peg it closer to 125 lbs/yr/capita). In either case, this 70-year increase exceeds that of the 350 preceding years significantly, at the outset of which The Bard of Avon wrote his famous line, and when average annual sugar consumption was just 4 lbs. per person. That means we ingest 30-40 times the amount of sugar today as we did 400 years ago. In his comment about sweetness, Shakespeare wasn't talking about sugar, per se; but he was using the metaphor to suggest, effectively, that something’s label doesn’t change its nature.

Sugar’s ‘nature’ is to be a key source of energy for all living creatures – plant, animal and human – and it provides us all with a significant portion of our collective calories in the form of carbohydrates. In biochemical terms, carbohydrates are sugars, since all carbohydrates [except for fiber, which we will discuss shortly] are comprised of one or more forms of sugar molecules that when digested - whatever their form - are converted into glucose by our bodies for distribution to our cells as fuel. For the purposes of this post, therefore, we will often use the words carbohydrate and sugar interchangeably, to make certain points. But first, we’ll provide an in-depth explanation of the relationship between carbohydrates and sugars.

According to the USDA’s 2010 Dietary Guidelines for Americans, we should consume 45-65% of our calories form carbohydrates, which translates to between 900 and 1,300 calories (or between 225 and 325 grams) of a 2,000-calorie diet. Carbohydrates come in 3 basic forms: sugar, starch and fiber. Sugars are fairly straightforward: they are either naturally occurring (i.e.: integral to the foods we eat, like those in fruit, milk, etc.), or ‘free’, aka ‘refined’, aka ‘added’ (i.e.: extracted from naturally occurring sources via processing and either consumed separately, like table sugar, or added to manufactured foods like cakes, breads, cereals, junk food, yogurts, etc.) Starches are simply multi-molecule sugars whose bonds (like links on a chain) are broken once digestion begins, following which they are converted into simple glucose molecules. Thus in practical biochemical terms, starches are no different from sugars. They naturally occur in so-called ‘starchy’ vegetables like peas, corn, potatoes and beans, and in all grains (bread, pasta, rice, cereal, pastry, chips – essentially anything made with flour). Fiber is the indigestible structure of a plant, which the body cannot break down, use for energy, or even digest. Fiber’s two main roles in digestion are 1: it slows down the process, by forcing the body to break down the ‘structure’ of the food in order to release ‘trapped’ nutrients into the bloodstream, sugars included; and 2: it cleans out the bowel, since the indigestible ‘bulk’ must exit, and as it does so, it acts like a broom for whatever is in the digestive tract. Biochemically, therefore, fiber is nutrient-neutral, and so we won’t discuss it further in this post. Suffice it to say that from the standpoint of nutrition, there is really only one thing worth discussing with regard to carbohydrates, and that is sugar. Hence, as mentioned above, we will use the two terms freely.

Food labels

Manufactured foods (i.e.: anything other than foods in their naturally occurring state) that are sold in the United States are required to provide a nutrition label on the food’s packaging that includes a number of metrics, such as a tally of its carbohydrates. To derive the amount of carbs in a food, manufacturers subtract fats, protein, moisture and ash from a food and weigh the remainder. They then measure that against the recommended 300-gram (average) daily maximum recommended intake to derive the percentage of the daily carb total that a serving of their food represents. Simple, right? Not so much.

The 'total carbohydrates' line on the label does include all three forms (sugar, starch, fiber) mentioned earlier. However, only fiber and 'simple' sugar content are individually tallied on their own lines beneath it. What is excluded from the sugar content listed, for some inexplicable reason, is a tally of a food’s starches, which we now know are also sugars, since biochemically, starch = sugar, and our food labels don’t (or are not required to) capture that.

I find the exclusion of starches from a food label’s ‘sugar’ tally at best disingenuous to people trying to understand and limit sugar consumption, and outright dangerous to people with serious diseases like diabetes, hypoglycemia (low blood pressure) or hyperglycemia (high blood pressure), the risk and severity of which are all directly influenced by the amount of starches they consume. The key is in controlling not just the amount of carbohydrates consumed, but the quality and type as well. The less refined and more natural it is, the less risk carbs incur. A good article on webMD can be found here. Whether or not you suffer from a blood sugar disease, if you're interested in knowing just how much sugar you are actually consuming (we all should), then as a workaround to the food label omission, just subtract the 'fiber' content listed from that of 'total carbohydrates'. The remainder can fairly be considered to be its ‘true’ sugar load.

Even in terms of the sugars that are listed on a food label – or anywhere else, for that matter, the USDA won’t tell you how much sugar you should (or should not) eat, or how it measures against a daily recommended limit. That is because the sugar industry has continually and successfully lobbied the US government to hide this information from food labels and consumers for decades, arguing (correctly) that doing so would negatively impact their ability to sell sugar and market their products. Thus we are forced to go outside of the US government to find out how much intake we should not exceed. The American Heart Association recommends we consume no more than 37.5g/day (150 cal.) of sugar for men and 25g/day (100 cal.) for women. To me, this seems more than reasonable, when you consider that just 400 years ago we consumed just one fifth of what the AHA is now recommending as a limit - a limit which in itself is just one fifth of what the typical American now consumes. Globally, the US leads sugar consumption, according to Euromonitor, which is unsurprising, given our elected representatives’ close and often muddied relationship with corporate America, as we discussed in brief in Week 2's post. The next closest country on Euromonitor's list – Germany – consumes one third less sugar than Americans do. India’s billion-plus people are at the bottom of the list, consuming on average just 5g/day each – the near-equivalent to what we, too, used to consume during Shakespeare’s time.

It needs to be said that without glucose, whether ingested from food sources or synthesized by our bodies’ own stores, we would essentially cease to exist. [Conversely, we could not survive solely on glucose, absent all the other nutrients the body needs in sufficient supply: the vitamins, minerals, amino acids (proteins), fats, phytonutrients and enzymes we have discussed at length in prior posts.] As we mentioned in brief, carbohydrates in whatever form they are ingested – table sugar, soda, fruit, breads, pastas, chips, dairy, sweets... – are broken down during digestion and converted (if necessary) into glucose molecules. These molecules are then carried via the hormone insulin through our bloodstream, hence the term blood sugar, to our cells where they are used as fuel. When carbohydrate-sourced glucose is absent or in inadequate supply for our body’s needs, and/or when our internal glucose stores are depleted, it turns to fats to turn them into sugars called ketones that healthy cells can use in place of their preferred fuel. In short, no matter what raw form a food takes, the body must convert consumed or stored fuels into glucose (or glucose-like sugars, like ketones) in order to for them to have utility.

In 2011, Gary Taubes wrote a memorable cover article for the New York Times Sunday Magazine provocatively titled Is Sugar Toxic? In the article, the Swiss biochemist Luc Tappy, considered by researchers in the field of sugar to be the world’s foremost authority on the subject, dropped a bombshell when he said that there was “not the single hint” that one form of sugar was any different from any other, biochemically. Meaning, the high fructose corn syrup that an increasing number of Americans now understand is bad for you is no different from the starch sugars in a slice of healthy 7-grain whole-wheat bread or the fructose in your just-picked apple. Sugar is sugar. But how is this possible? Is a Double-Gulp from 7/11 no worse for you than a ‘sugar-equivalent’ number of apples?

No – not by a long shot, which is where Tappy makes his (chemically correct) scientific point at the expense of painting an equally critical context of how we consume sugar and our bodies process it, for those among us who want to understand why our fixation with it is legitimately, slowly, killing us.

I can hear it now: ‘Wait. You just said that sugar consumption is essential to life, and that it’s ‘killing us’ in the same breath. So which is it?’

There are five critical measures when it comes to sugar that make an enormous difference in both the immediate and ultimate outcomes of its consumption:

The quantity of sugars we consume (calories)
The speed with which our bodies metabolize them (glycemic index)
The brain’s evolutionary biochemical reaction to sugar (hunger and addiction)
The presence [or absence] of other nutrients (nutritional completeness)
The direct relationship between sugar and illness (biological stage-setting)

I will tackle each topic sequentially in this post, for us to better understand our relationship to sugar, how to ‘do sugar right’ and where the Western Diet fails our bodies and leads to chronic illnesses like diabetes, heart disease, hypertension and depression, or even more seriously, cancer and death.

But first, some history.

(Re)enter the post-war era, with which we began this post. Following World War II, the industrial food complex – enabled both by direct federal subsidy and legislation – capitalized on ever-more efficient – and synthetic – ways of delivering sugar to consumers. Production skyrocketed, and along with it, unsurprisingly, our conspicuous over-consumption, both knowingly (via junk foods like sodas and sweets) and unknowingly (via processed anything and dairy). Today, post-industrial sugar has over 60 names and hides in over 74% of all processed foods according to sugarscience.org, and is perhaps the single greatest cause for the raft of maladies that plagues post-war global culture.

As we reported in Week 15, President Franklin Delano Roosevelt, upon entering office at the height of the Great Depression, quickly passed the 1933 Agricultural Adjustment Act (AAA) to shore up farmers, focusing on major 'commodity crops' like corn, soy, wheat and rice, all of which are carbohydrates, and all of which are present and in many cases dominant in most packaged foods. Roosevelt’s legislation paved the way for subsidies that are still in place today, putting the selection of 'produce crops' like vegetables, legumes and fruits at a great financial disadvantage to farmers trying to make a living. In fact, over 90% of all subsidy funding in the United States goes exclusively to the four 'commodity crops', according to the Cato Institute, as we reported in Week 6, along with cotton, which we don’t eat.

Subsequently, as we reported in Week 2, President Richard M. Nixon’s Secretary of Agriculture, Earl Butz, struck two historically consequential deals insofar as industrializing food. The first of these was with the Japanese, who in the mid-70’s created a new sugar-replacement from corn called high fructose corn syrup (HFCS). Because of corn's robustness and consistent yields, this promised to stabilize and dramatically lower the price of sugar, which regularly seesawed up and down alongside volatile cane production in the West Indies. Butz created policies and economic incentives to move growers away form traditional produce crops (the vegetables and fruits) toward commodity crops like corn to maximize production, make the US the world’s largest producer of HFCS and drive down costs. Ultimately, his work guaranteed the place of ‘king corn’ in the US, where it comprises over 30% of all farmland today. When combined with the other ‘big three’ crops mentioned above, we find that the vast majority of US crops come from just four carbohydrate-laden sources, which bring with them a hostile environment for growers of other non-subsidized food enterprises. They are found lurking in processed foods everywhere, masquerading under dozens and dozens of unrecognizable names.

Finally, as reported in Week 4, Senator George McGovern convened a now-infamous panel of experts in 1976 to determine why Americans were getting fatter and experiencing an increase in heart disease. The panel, pointedly comprised of just two ‘experts’ alongside the elected officials, concluded that Americans were gorging on fat-rich, cholesterol-rich and sugar-rich meals, and that this was the root cause of the spike in chronic illness. Whatever the accuracy of these statements, the chief outcome of the just-published study was that - sensing the potential for market share loss in their businesses - the dairy, egg, sugar and beef associations banded together for the first time lobbied their demand for a governmental rewrite. They succeeded in getting the government to remove the suggestion to ‘reduce intake’ and replacing it with advice urging Americans to buy more food with lower fat content, thereby leading to an increase in sales and an entirely new market on which the industries could capitalize. The ultimate results? Americans have spent the past 40 years shunning healthy fats and harmless dietary cholesterol, while replacing those valuable, nutrient-rich calories with carbohydrates (sugars), because we were told that the latter provided our bodies with fuel without the health risks, and with fewer calories. Since this policy was put into place, our average net daily caloric intake has jumped from 2,000 in the 70's to a teetering 2,700 – a full 1/3 increase. Per Gary Taubes: "In retrospect, it's kind of amazing, but this was the thinking at the time."

So here’s what you need to know about sugar.

Issue 1: Quantity – the Overdose

We’ve mostly discussed this already. Americans consume far more sugar than they should – well over even their own historical norms and dwarfing that of every other country on Earth. We know beyond repudiation that the primary health impacts of excess dietary sugars are obesity, diabetes, heart disease and cancer, due to both an increase in caloric intake and the body's over-production of triglycerides (fats) to capture all the sugars that we keep ingesting at a pace that outstrips how fast our cells can metabolize them. We all know with great frustration that once fat tucks itself into the corners of our bodies, it’s far harder to remove than we’d like to admit. Our bodies evolved to be experts in conservation.

With regard to cancer, it gets more interesting, and we will be creating a separate post on the subject of low-sugar diets and cancer. There is emerging proof, as more researchers study Ketogenic Diets, that a lack of available glucose can starve cancer cells. A Ketogenic diet is one that is high in good fats and low in sugar that essentially forces the host metabolism to ‘switch’ from burning glucose as its primary fuel to burning fat-sourced ketones, which it does for as long as our dietary intake promotes it. Our bodies favor glucose, as we know, and so this is the first nutrient to be converted to energy. But as we pointed out earlier, when there is an inadequate supply of glucose to fuel the body, it starts to convert fats into ketones and hums along happily in the process. A 2012 paper published in the journal Molecular Systems Biology Dr. Thomas Graeber, a professor of molecular and medical pharmacology, demonstrated that "glucose starvation - that is, depriving cancer cells of glucose - activates a metabolic and signaling amplification loop that leads to cancer cell death as a result of the toxic accumulation of reactive oxygen species (ROS)". He's not alone. Dr. Valter Longo is a biogerontologist and cellular biologist who has spent years studying the effects of [glucose] starvation, aging and diseases, like cancer. He believes unequivocally that fasting cycles retard the growth of tumors. Here's one video in which he explains his research and conclusions.

There are a number of scientists - like Dr. Longo, whose forthcoming ProLon will market a dietary regimen that he asserts will result in the wholesale reset of our immune systems and collapse of mutated cells, like those in cancers - as well as dietitians who have commercialized some version of this approach. They are scientifically referred to as ‘Starvation Diets’ though usually marketed as something much less macabre, like Michael Mosley’s 5:2 fast diet, or he-man Martin Berkhan’s LeanGains. While the dietitians are mostly interested in fat loss, and the scientists in cancer, the biological rationale is consistent: in pre-agricultural times the foods we hunted or foraged weren’t in consistent supply. We thus went through regular periods of ‘feast or famine’, and our bodies’ own biology evolved to expect this and compensate. It’s why we are, biologically, able to switch between sugar- and fat-based energy conversion: there are simply times when certain nutrient sources were not available.

Recently, scientists like Dr. Longo and Dr. Graeber have pointed to cancer cells’ particular affinity for sugar. One already well-established cancer treatment – Insulin Potentiation Therapy (IPT) – uses sugar deprivation to get cancer cells in ‘true Stage IV’ cases to respond robustly with much lower doses of chemotherapy than is typical – thus IPT is considered less invasive. “Cancer cells have much higher levels of insulin receptor sites than do healthy cells, to increase glucose uptake”, according to the websiteCancerActive. In simple terms, cancer cells are glucose addicts. Additionally, cancer cells have “defective mitochondria”, and according to the website, “without glucose, they [the mitochondria] kill the cell.”

As I mentioned, we will create a separate post on starvation diets, their impacts on health, including cancer, and whether this is just the latest fad or a turning point in dietary science. It’s enough here to point our the particular relationship of cancer cells to glucose; and that this affinity – or chemical dependence – is potentially cancer’s Achilles heel.

Issue 2: Speed – the Glycemic Index

As you now know, from a root nutrient standpoint all carbohydrates are sugars, with the exception of fiber, which we have discussed. These sugars have many names: glucose (as we’ve discussed at length), fructose (fruit sugar), sucrose (table sugar from beets or cane), maltose (grain sugar), lactose (dairy sugar)... and all other ‘oses’. Whether these sugars are ‘simple’ – i.e. made up of a single sugar molecules that convert quickly to glucose, like those in fruit, or ‘complex’ – i.e. made up of glucose molecules that are strung together, like those in breads, and broken down into simple sugars during digestion, these sugars are ultimately indistinguishable in the blood stream, where glucose is glucose is glucose. The difference between sugars lies primarily in the speed with which they are converted, absorbed, and used by the body’s cells.

To give an example, let’s take fruit juices, which are overwhelmingly devoid of fiber (and thus, in our opinion, should be avoided entirely – no matter how expensive or fresh it is). When a glassful is consumed, all of its sugar is released immediately, the rush of which generally overwhelms your body, creating an energy boost (aka sugar rush) that gives you 'energy' (pep), but sends your pancreas into overdrive producing insulin to capture and distribute the glucose to your cells as quickly as it can. Both your pancreas and your cells have limits: there is only so much glucose the body can absorb at once, and that amount is fairly low – hence the rush. Just picture pouring water into a funnel faster than the opening at bottom can evacuate it; the funnel overflows. In your body, this overflow of sugar is captured by triglycerides (fat packages that are produced by the liver) and stored in the body for future use, like squirrels store nuts in the winter. Unlike the foraging squirrel, a healthy liver has an infinite capacity to generate triglycerides, and your body has an infinite capacity to store them. When this biological process is applied to the extreme sugar-saturated diet of the average American, rich in grains, starches, pizza, canned soup, ketchup, snack foods, juices, cheeses, sodas, sweets and any other product with added sugars, the expected, all-too-common result is obesity, which afflicts more than 1/3 of all Americans, with 2/3 of us considered overweight and well on our way.

By contrast, let’s compare the consumption of orange juice against that of an equal amount of whole fruit. The major difference is in the orange's fiber. As you now know, a plant’s nutrients are stored in its (indigestible) fibers, which must be broken down by your digestive system in order for the plant to release them for your body's use. As it does so, a food’s sugars, vitamins, minerals, fats and other nutrients are incrementally released throughout the duration of digestion. Fibrous foods reduce sugar spikes because they release nutrients slowly – not at once, as it does when we drink juice. Thus insulin production doesn’t go crazy, and triglycerides aren’t produced. Two additional benefits of a fiber-rich diet are that A – fiber makes the body feel fuller, longer, by taking up space and by signaling the brain that it’s full, which ends cravings; and B – the indigestible fiber pushes other foods down the chain until they come out, keeping you ‘regular’ and flushing out toxins (which all foods contain) faster.

We refer to the speed with which sugar digestion occurs as its Glycemic Load. There's an index for that.

Fiber-rich foods rate low on the Glycemic Index, while fiber-poor foods rate high. The Glycemic Index is a list of carbohydrates that are assigned a value (from 1 to 100), which correlates with the speed with which they are converted to glucose and absorbed by the bloodstream. A top rating of 100 means pure glucose; while a (theoretical) rating of 1 means it’ll take ages for the bloodstream to extract a food’s glucose. The lower the number, the better it is for your health, and the less chance that food will trigger digestive chaos and fat production. Accordingly, it’s no surprise that most vegetables peak at a glycemic load below 15; most fruits at below 50; and most processed foods rate above a 50 on the GI. This is because vegetables and fruits are fiber- and nutrient-rich whole foods; while processed foods are generally fiber-poor and nutrient-poor, even if they’re made of grains like corn or wheat that were fiber-rich before they were processed into flour. Specifically, the milling of wheat into flour destroys its fiber, in addition to most everything else that’s good about it. Once it is milled, all that’s left is a grain's sugar – its carbohydrate. Because processing is so destructive, manufacturers often ‘enrich’ foods by adding synthetic forms of the natural nutrients that the manufacturing process destroyed. We know from Week 10 that supplements and enriched foods are poor substitutes for naturally occurring nutrients in their unadulterated host form. Here is a listing of 100 common carbohydrates and how they rate on the Glycemic Index. You may be surprised at some of the foods that you commonly eat, and until now thought were healthy.

Issue 3 – Addiction and Sugar

Dr. Howard Moskowitz is known in the industry as ‘Dr. Bliss’. According to Dr. Mercola, Moskowitz – a Harvard-trained mathematician – helps processed food manufacturers “find the ‘Goldilocks’ zone of sugar, unhealthy fat and salt in order to get you to overeat and buy another bag or box even though you know you shouldn’t. And he’s made the sugar industry billions.”

Robert Lustig, MD – a pediatric endocrinologist at UCSF and the author of several books, including ‘Sugar Has 56 Names: A Shopper’s Guide’, says about sugar, “No one can exert cognitive inhibition, willpower, over a biochemical drive that goes on every minute, of every day of every year.” He is also the co-author of the AHA’s 2010 recommendations on daily sugar limits, which we mentioned earlier. In a well-written 2014 article for The Atlantic called ‘The Sugar Addiction Taboo’, Dr. Lustig proposes that it’s time to look in the mirror and ask ourselves, ‘Did I really need to eat the whole box of chocolates,’ and goes on to describe Binge Eating Disorder, a newish label created by the American Psychiatric Association (APA) for just such a phenomenon. The disorder's legitimacy is further supported by Nora Volkow, director of the National Institute of Drug Abuse. Lustig goes on to distinguish between ‘liking, wanting and needing’ foods, labeling the last term an addiction. Sugar defenders say, ‘It’s food – how can it be addictive if we need it to live?’ to which Lustig cleverly –critically – distinguishes between nutrients whose absence causes deficiency diseases, like those of vitamins, minerals, fats and proteins, and those who simply don’t, like sugar. “Alcohol is energy, but it is certainly not required for life. There’s no biochemical reaction that requires alcohol.” He then goes on to say – in a corollary – that “As it turns out, there’s no biochemical reaction that requires fructose,” and in another blow to carbohydrate consumption, “glucose... is not essential – it’s so important, that if you don’t eat it, your liver will make it.”

In his Atlantic article, Dr. Lustig cites an abstract by the Society of Neuroscience in which rats were found to prefer Oreos to cocaine. An unrelated, ongoing Columbia University experiment by Dr. Nicole Avena exposes rats to sugar water in 3-week increments, then as she subsequently deprives them, she watches them exhibit every single sign of addiction: binging, withdrawal, craving and addiction transfer (aka co-addiction). In yet other studies involving MRI scans of brains exposed to sugar, only sugar lights up the reward center of the brain – the ‘feel good’ center that Dr. Moskowitz is such a genius at manipulating that we empty bags of chips and demolish tubs of ice cream without stopping to process the reasons or to self-regulate. And while Dr. Moskowitz uses the triumvirate of sugars, fats and salt, the latter two do not trigger the reward center of the brain – hence fat and salt are non-addictive, which leaves only sugar as the prime culprit in our tendency to binge on sugary foods. Worse still, the dopamine that the reward center releases upon receiving cocaine or sugar is apparently also a down-regulator, meaning with each subsequent exposure to a familiar drug, it spikes a little less, requiring more of the same to produce the same effect over time.

Some 77% of all American supermarket foods contain added sugar.

Issue 4 – Nutritional Completeness

This one should be self-evident, but given the food choices people make, let's revisit the illustration of oranges and juice, in greater depth, and contrast it to another popular and iconic sugar source: Coca-Cola. A 282g (10 oz.) Burger King kids' size Coca-Cola Classic (yes - kids' soda) has 123 calories, all of which come from its 31g of sugar – a full day’s worth of carbohydrates for an adult, according to the AHA recommendations we discussed earlier. That's all it has. The Coke does not contain a single trace of any vitamin, mineral, fat, protein, phytonutrient or enzyme - that is, nothing of any biochemical value to us, whatsoever. It is as empty as empty gets, nutritionally.

By contrast, a 248g (8.7 oz.) cup of raw orange juice has 112 calories, which is the same calorie-to-volume ratio as the Coke. While the juice delivers a significant 21g of sugar, there are major differences. First, that amount is just 2/3 that of the Coke – a significant relative reduction. Second, the juice provides 2g of protein, 10% of your daily vitamin A, 207% of vitamin C, 15% of thiamin (B1), 4% of riboflavin (B2), 5% of Niacin (B3), 5% of B6, 19% of folate, 5% of pantothenic acid, 3% of both calcium and iron, 7% of magnesium, 4% of phosphorous, 14% of potassium, 1% of zinc, 5% of copper, 2% of manganese, and trace amounts of necessary fatty acids. That is to say, orange juice is a good to excellent source of over 17 essential nutrients.

If we take the comparison to its next logical step, and eat 2 medium oranges in place of downing the juice, they will deliver the same calories, vitamins and minerals as the juice, but also deliver 3g – or 13% - of your daily fiber, which as we have seen both aids digestion and, critically, slows the metabolism of sugar, thereby reducing spikes and crashes while helping you to feel full. Sugar without fiber, regardless of vitamin and mineral content, does not satiate, as we've seen. In fact, it does the opposite, signaling the brain to eat more, which causes us ultimately to overeat (or drink).

In short, soda is both empty and toxic. Juice is a major vehicle for delivering a raft of essential nutrients, but leaves you hungry, since its calories and sugars are immediately available and quickly consumed. A piece of fruit too provides the nutrients, while providing fiber that results in less consumption via slower digestion, resulting in less body fat and less addiction. The same holds true of any whole food when compared against an 'equivalent' manufactured and/or processed food product.

So skip the calorie-counting. It’s frankly moot, and a major distraction to what we should be looking for: nutritional completeness for health and fiber to regulate digestion. Nature takes care of the rest without using a calculator.

Issue 5 – Sugar and Illness

By now it should be painfully clear that sugar isn’t healthy, for a number of reasons: 1 - It’s addictive, leading to overconsumption. 2 - It's nutritionally empty. 3 - It is biochemically non-essential. 4 - In the absence of sugar, the liver produces its own.

We should be mindful that in spite of the fact that humans have not evolved, biologically, in the past 400 years, we have nonetheless increased our sugar intake epidemically, from 4 lbs./year in the late 1500’s to between 125 and 170 lbs./year in 2000 – a roughly 30- to 40-fold increase, half of which has occurred in just the past 70 years alone, since which time food science has shifted our diets from real foods that feed the body to manufactured ones that feed corporate shareholders. We know it's not good for us, and yet we are clearly ignoring the signs.

We are not to blame. Much like Dr. Robert Oppenheimer – who was simply a man of science and had no personal drive to obliterate entire Japanese villages with the nuclear weapon whose creation he led – Dr. Moskowitz is just a mathematician with a gift for creating the ‘perfect storm’ of food addiction. And he’s not alone. Arguably, his (and his colleagues’) wake of destruction may well exceed that of Dr. Oppenheimer, since while the use of a nuclear bomb is both immediate and visibly catastrophic, leading to global bans and acute fear of its capability, obesity, diabetes, heart disease and cancer are quiet, slow and mostly invisible until they have caused severe and often fatal damage. And damage they have caused. As we wrote in Week 8 - the National Cancer Institute and Harvard University's School of Public Health propose that dietary factors account for 30% of all cancers, making it second only to tobacco use in cancer causes.

We must therefore [if health is an agreed goal] consider the consequences of things when we make choices like what to eat - not just the incremental steps, but what a year or sixty years of steps looks like. We must take the long view. In the long view, a little sugar here and there isn’t an issue. In part, the body needs it, and is made to handle it. I also personally believe that should indulge every now and then in choices that make no sense but make us feel good. The key, however, is in the frequency and severity of our choices. A little is not a lot. A fruit is not a juice is not a soda, yet all three are available, and arguably the least expensive choice is also the healthiest. Beans are cheaper than a bag of chips. They also provide more calories and a ton of nutrients. They satiate your body longer, and promote health. On the flip side, chips lead to the diseases we keep discussing, week after week.

Eating healthy foods is inexpensive. Eating unhealthy foods is not only expensive with respect to your wallet and grocery bill, it’s catastrophically expensive with respect to healthcare costs and taxation, since ultimately it’s all taxpayers who foot the bill for people’s bad food choices, not just those who suffer from it directly. Obesity alone cost the United States nearly $200 billion in direct outlay in 2005; and more than $4 billion in job absenteeism due to an increase in sick days, adding proverbial insult to literal injury.

Smell the rose. Know her by all her names, and rejoice in how perfect Nature made her, without help.

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