Why Can’t I Keep The Weight Off?

Why Can’t I Keep The Weight Off?

#StripTheNonsense

Why Can’t I Keep The Weight Off?

Katherine Kimber, Registered Dietitian & Caitlyn Campbell, Student Dietitian.
September 18th 2019

It feels like everyone and their brother has been at this place: They’ve gone on a diet, lost some weight, and despite their best efforts, the weight and more may have come back on. With this, family or their doctor may have said, “Well, they probably just got tired of the diet” or say something silly about willpower. But is the answer really that simple? Why is it that most people can’t keep it off?

There is an idea called set-point theory and it theorises that every unique individual has a weight range their body likes to be at. Some people’s bodies may stay at the lower end of the spectrum while other bodies may stick to a higher size.

This idea is a bold statement.

How could potentially a body be meant to be large?

A multibillion-dollar diet industry has even been built upon this idea that large is unhealthy and we must become smaller for the sake of health. 

But if set point theory is true, wouldn’t that mean some people are just high weight and that is that?

Let’s see what the science says… 

The Science of our body weight

Scientists have noticed for some time that our weight loss methods aren’t effective in the long term. In a study published twenty-five years ago, scientists who recognised the futility of dieting decided to see what happened when they made subjects in two groups either lose 10% of their body weight or gain 10%.* After measuring how much energy the participants used (like how many calories they needed in a day) they divided the groups and measured how their energy needs changed after weight loss or gain.

The results?

In the first group, after gaining 10% of their body weight, something happened. Their bodies adjusted how much energy they were using. The weight gain was correlated with their bodies using up more energy than they were previously. The participants fell back down to their usual weight. Those who lost 10% of their body weight saw the opposite effect. Their bodies started using less energy. The participants in the weight loss group once again went back to their usual weight. 

In summary: The energy usage of the study participants bodies changed to either be more or less efficient so the participants would bounce back to their usual size. 

This study was back in 1995. That could mean one of two things:

  1. It is now outdated
  2. It was an early indication that body size management was much more complex than diet and exercise.

In more recent years, scientific studies have not only found similar results to the 1995 study but have gone a little further. 

 

More Science – The Biggest Loser Show

 

There is a famous study that looked at the metabolism changes of participants who were on the television show, The Biggest Loser. For those of you who are unfamiliar with the show, it is a weight loss competition. In this study, we saw further indication for set-point theory, but also realised that set point, rather than being a single number, is on a sliding scale and may change with years of dieting. 

The participants in the study had all, but one person, regain a significant amount of weight back by the time of the 6-year follow-up.** 

The one participant who hadn’t regained a significant amount of weight had a medical procedure called a gastric bypass or weight loss surgery. There is some scientific thought that for an unknown reason, a gastric bypass impacts the body’s ability to use energy differently than from standard dieting. They were more likely to keep the weight off (you can read additional information on bariatric surgery at the bottom of this article). 

Regardless, the important findings of this study showed that the participants who hadn’t received gastric bypass surgery had changes to their metabolism that seemed bent on having them not keep the weight off. Those who had the most, “success” over time at maintaining their weight-loss, had proportionally greater slowing of their metabolism. In other words, they needed consume fewer and fewer calories as time went on in order to keep it off. 

In summary: Their bodies were bent on altering their metabolisms to stop them maintaining the lower size. Keeping off the weight loss therefore required an extreme amount of attentiveness. We see that the longer the weight loss is maintained, the greater the human body will try and counteract that loss through the slowing of the metabolism. 

Other factors involved in maintaining body size include shifts in hormones such as ghrelin, a hormone related to hunger. Ghrelin increases during weight loss causing increased hunger, designed to make us eat more and store more body fat. These are survival mechanisms when it comes down to it. Your body doesn’t know the difference between a long-term famine or a short-term diet.

What about genetics?

One way for scientists to control for genetic influences in their work is to study twins. One example of this is a scientific research article entitled, “Does dieting make you fat? A twin study”.*** The twins that partook in intentional weight loss pursuits gained more weight over time than their twin. In females, this result was even steeper. With every attempt of intentional weight loss, the researchers saw proportionally greater weight gain. These results didn’t change after the researchers controlled for factors like BMI, social class, and smoking. 

In summary: The study concluded that more dieting resulted in more weight regain. These findings provided further indication that dieting had the opposite result of its intent.

What about NEEDING weight loss for Type 2 Diabetes management?

This is interesting in the context of conditions like type 2 diabetes where intentional weight loss is a normal recommendation for treatment. An intensive lifestyle study aimed at weight loss in the scenario of type 2 diabetes was actually discontinued. Why you ask? The efforts were labeled as “futile” by the researchers after the intervention had not impacted rates of heart disease related outcomes.**** 

In fact, we know that since there isn’t a method of sustainably maintaining a lower size, regain after dieting will likely occur. According to Lauren Newman, RD, 

“Weight cycling (yo-yoing) increases insulin resistance and I never see that acknowledged in the diabetes world.”

Weight cycling occurs with repeated weight gain and loss over time. If there isn’t a scientifically proven weight loss diet to work, we are essentially sending these patients down a path of yo-yo dieting without considering the consequences yo-yoing holds to insulin resistance.

Overall, due to our body’s complicated mechanisms of maintaining our present body size, there seems to be minimal chance of keeping the weight off. Efforts should be put into behaviours that can be controlled, such as dietary changes, participating in joyful movement, stopping smoking, and reducing alcohol intakes. Body size is not a behaviour. 

In summary

Difficulty in keeping the weight off can be due to a multitude of factors: from the discontinuation of the diet due to unsustainability, genetic conditions, to of course set-point theory.

 

Why it's so hard to maintain weight loss

 

In the consideration of the achievability of keeping the weight off, the set-point theory cannot be overlooked. We know our body changes in response to restriction and excess, that dieting is associated with greater weight gain over time, and that in the long-term diets fail 95-97% of the time.

All of this information should come together to indicate that our bodies will fall where they want to fall in the context of food freedom. Unrestricted eating in the intuitive eating framework is an opportunity for folks to land on their body’s current set point in way that protects mental and physical well-being. Our bodies are meant to change and adapt over time. Set-points are not a notion of one stable number, but rather the acknowledgement that at different points of your life, after facing varying and unique exposures, your body will make adaptations to achieve the size it is comfortable being.

References

*Rudolph L, Rosenbaum M, Hirsch J. Changes in Energy Expenditure Resulting from Altered Body Weight. New England Journal of Medicine. 1995;333(6):399-399. doi:10.1056/nejm199508103330628.

**Fothergill E, Guo J, Howard L, et al. Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity. 2016;24(8):1612-1619. doi:10.1002/oby.21538.

***Pietiläinen KH, Saarni SE, Kaprio J, Rissanen A. Does dieting make you fat? A twin study. International Journal of Obesity. 2011;36(3):456-464. doi:10.1038/ijo.2011.160.

****Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes. New England Journal of Medicine. 2014;370(19):1866-1866. doi:10.1056/nejmx140022. 

 

Are Diet Pills Effective? The Low Down From a Registered Dietitian

Are Diet Pills Effective? The Low Down From a Registered Dietitian

STRIP THE NONSENSE

Are Diet Pills Effective? The Low Down From a Registered Dietitian

By KATHERINE KIMBER, Registered Dietitian & CAITLYN CAMPBELL, Student Dietitian 

September 5th 2019

Waking up every day in a body that you wish wasn’t yours is more than challenging, it’s all consuming. Holding onto the trousers that are just too tight but are in your wardrobe anyways because you can’t help but hope that one day, they will fit like they used to. Then wearing ill-fitting trousers and continuously thinking about the way the button’s pressed up against your stomach. Then spending the day trying to eat feeble amounts of food in an attempt to lessen the discomfort of wearing tight pants.

Day-in and day-out is taxing.

So at night while scrolling through social media, thinking about all the mistakes you made in your pursuit of thinness that day, you see an advertisement. This may feature a pretty looking woman or toned young man and the advertisement claims that they just had to take a pill and became their inner thin person. And while we know the concept of having an inner thin person is just wild because we are who we are, no matter our size, this advertisement is alluring. Even those of us trying to ditch diet culture (see the article Fear of Gaining Weight) can’t help but pause at the image of a fast-pass to being thin.

Despite all we know about diet pills being a big question mark of unknown side effects and problems, the idea of them draws us all in.

Why is that?

Social influencers playing on insecurities 

We live in a society that places a high value on weight and body size over health and wellbeing. It’s not surprising that people are looking for quick fixes like diet pills to shrink their bodies. Companies are subsequently making a lot of money playing off of people’s insecurities. After all, we’re sold this idea that thinness equates to increased happiness, confidence, improved health and success. This influence gets us to that place of having clicked on the weight loss pill advertisement and debating whether or not to rush ship the pill bottle full of a mysterious substance that, “melts fat” right off of you.

Choosing where we get our nutrition information from can be extremely confusing  and sometimes it is easy to equate Instagram followers to authority. This account: @sarahjohnson.stanford is an example of someone who is advertising diet pills, and using their 211k following their advantage. This account also links itself to the University Stanford which is known for its academic strength, adding a further false sense of security and credibility. Unfortunately, the wellness industry is not regulated which means that anyone can create a website and start selling a product without any qualifications. This is clearly an instagram account and website that’s done just that. 

False and unsubstantiated claims

Remember earlier when we mentioned that food products cannot make health claims? Anytime a food supplement that promises you results from weight loss to improved thyroid function, is probably making an unsubstantiated claim (claims that are not supported by evidence).

This particular Garcinia Vita Pills website makes false and exaggerated claims that are not supported by credible scientific research. Garcinia Vita Pills use the tropical fruit Garcinia Cambogia. The active ingredient Hydroxycitric acid (HCA) can be extracted from the dried rind of the fruit and its the HCA that is theorised to aid in weight loss by reducing appetite and/or by interfering with pathways that metabolise (break down) fat. 

They are promoting a quick fix and miracle cure to weight and health, which are both very complex. When I look into the research on Garcinia Cambogia, there has only been one systematic review of randomised controlled trials (high quality study) conducted where no meaningful weight loss was detected. The product claims to “improve digestion”, when in fact one of the reported side effects of Garcinia Cambogia in research studies is the complete opposite – gastrointestinal disturbances (gut symptoms). 

         This is just one example of the many products out there that is making false claims as a way to grab the consumers attention and manipulate them into buying a product they do not need.

This messaging isn’t innocent

This messaging leaves us consumers thinking “there can’t be any harm” in taking these “natural” pills.  But the truth of the matter is that there really can be. Terms like “natural” provide us with a comforting belief that it’s wholesome, gentle, unprocessed and therefore healthy. However, this term is ambiguous. The devastating effects of diet pills (especially over the internet) can be witnessed in the story of Aimee Parry (aged 21) who lost her life not so long ago. 

The Garcinia Vita Pill website does not offer a balanced picture of the product and does not highlight the potential risks to consumers. Scientists cannot conclude that Garcinia Vita Pills are safe and there are even cases of interference with medications (particularly antidepressants) and also acute liver failure.

         The messaging is a part of the smoke and mirrors that draws consumers into these products. It can be extremely tempting to believe the claims and hope for the miracle cure we’ve all been looking for. If you are someone who is really gung-ho about trying a product you see on the internet, try looking it up in the National Sanitation Foundation (NSF) Certified for Sport® database. They perform an extremely thorough assessment of products; professional sporting leagues will sometimes only allow players to utilise products that have been approved by the NSF. 

Diet Pills Are Not The Answer

         We put up with a lot of messaging in our day-to-day life that promotes thinness. As we talked about earlier, sometimes a quick fix is more than just alluring, the promise of no longer being in a body you don’t like, is intoxicating. But, the research is clear, diet pills are hardly a solution. If anything, they can hurt one’s health. I think that it is a good idea to take a step back and think about health in a bigger picture than body size. Jeopardising a life for a thinner body has to be something we talk about. It is a problem that diet culture has driven us this far to the edge of the cliff.

What are the ways health can be supported that have nothing to do with body size? I ask this because supporting health in a framework of body size has gotten us to this cliff. 

 

 

Can You Really Have Health at Every Size?

Can You Really Have Health at Every Size?

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Can You Really Have Health at Every Size?

KATHERINE KIMBER, Registered Dietitian

9th July 2019

One question that frequently echoes around the place of work, social media, and social circles, of many Health at Every Size (HAES®) practitioners is, “But, come on, can you really have health at any size?”. 

This question usually comes after an individual first hears about the social justice movement HAES®. They are immediately confronted with a lot of confusion. We are told from a young age by doctors, other respected professionals, friends and family that our weight is a major (if not sole) determiner of our health and morality. It is no wonder that the messages surrounding HAES® come with some confusion.

Understanding weight science is one of the first steps to heal your relationship with food. Hopefully this article can help alleviate some misperceptions as well as shed some light on the principles of HAES®.

What is Health at Every Size ( HAES®)?

Health at Every Size® is a set of principles to help us advance social justice and create an inclusive and respectful community. It’s been developed to support people of all sizes in finding compassionate ways to take care of themselves. The phrase, “Can you really have health at every size?” comes from a general misunderstanding of what HAES® is. 

HAES®  is kind of like you, living your best life, where body size isn’t situated as the star of the show. You and all the things that you cumulatively value, are the star. This is because the phrase, “health at every size” is different from the phrase “healthy at every size.” HAES® takes the approach of examining the whole person and not an isolated characteristic of the person (aka weight).

HAES®  is kind of like you, living your best life, where body size isn’t situated as the star of the show.

Image by Moose Kleenex

But doesn’t being high weight increase your health risks?

It turns out, despite decades of being told body size equates to health, new information indicates otherwise. Fat-phobia, or the fear of fatness, is rooted in many elements of our culture. Scientific researchers were and are, not exempt from that particular fear. Flawed research methods and a gross overgeneralisation of research results has added fuel to the fear of fatness.

Let’s look at some of the data…

The chart below is taken from a large study of 12,000 adults followed over 14 years below. It demonstrates that as a person partakes in more and more healthy habits (regardless of size), the risk of death reduces. 

If you look at the group with a higher weight (BMI over 30kg/m2) the risk of death is the highest when no positive habits are followed (on the left). However, when this group partakes in a few positive health behaviours the risk of death is no greater than that of a thin person partaking in the same activities. I repeat – the risk of death is no greater than that of a thin person partaking in the same activities regardless of their weight. 

These activities includes; physical activity, not smoking, reducing alcohol intake and increasing fruit and vegetable intake.

Image taken from Matheson 2012, paper in the Journal of the American Board of Family Medicine

Why you may not be receiving the healthcare you deserve…

HAES® allows healthcare practitioners to provide equitable care to all patients regardless of their size. Have you ever been to the doctor for something really irrelevant to your weight like an eye infection, and left with a pamphlet on weight loss? Or maybe the healthcare provider didn’t give you the time of day? Maybe they didn’t believe you when you said that you eat your vegetables, don’t smoke, don’t drink and exercise? These are examples of weight stigma and these instances likely lead to avoidance of going back to your healthcare provider and ultimately worsened physical and mental health. 

By taking a weight inclusive approach through HAES®, practitioners are acknowledging that assuming someone is healthy or unhealthy based on their size, is an unhelpful way to approach health care. Weight inclusivity acknowledges that an individual’s moral value and body size are not related to one another. One’s health is just that—their own health. Health can mean a lot of things to different people and we must all respect others in the ways they do, or do not, choose to pursue health. 

The next time you visit the Doctor, and are told you need to lose weight for the 1274848728762784 time, perhaps you could use some of these phrases instead;

Taken and adapted from “Dances with Fat”

Asking, “Can you actually have health at every size?” shoots us all a little off the mark of what is really going on.

This question distracts us from the real injustice: People of all body sizes are not getting appropriate medical care or respectful treatment due to weight bias. To make matters worse, experiencing weight discrimination deters the individual from participating in potentially beneficial health behaviours. Because diet culture places an emphasis on weight, overall health is sacrificed. 

Maybe you’ve experienced this during a time when you felt light headed and fatigued, but still didn’t eat, for the sake of a weight-related goal. Or maybe you’ve sacrificed a personal relationship for the sake of maintaining a diet. Whatever it may be, chasing a body size distracts us from other important aspects of our lives and health. 

Rather than asking, “Can you actually be healthy at every size” we should all be asking, “Regardless of body size, in what ways, can we support health and well-being?”. The latter question acknowledges that all bodies are worthy of respect and compassion and that there are many ways in which we can support our health that have nothing to do with the size of our bodies. 

Rather than asking, “Can you actually be healthy at every size” we should all be asking, “Regardless of body size, in what ways, can we support health and well-being?”.

 

Final Thoughts

Well, I warned everyone that this question wasn’t going to have a straightforward answer, but here we are. “Can you really have health at every size?” is a question that misses the mark. It fails to acknowledge that Health at Every Size® does not equate itself to the phrase Healthy at Every Size. Even so, as we examine new research, scientists are beginning to piece together that our health behaviours may play a more crucial role in our health than body size alone. 

Finally, the question itself, is a distraction from the real injustices occurring in our society. In order to correct the damages that weight discrimination has done, we must confront our own internal biases and work towards a better world. With that, I leave the readers of this article with a question. The next time you hear, “Can you really be healthy at every size?”, how will you respond? 

 

Am I addicted to sugar?

Am I addicted to sugar?

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Am I addicted to sugar?

KATHERINE KIMBER, Registered Dietitian

1st May 2019

I am often asked by clients whether sugar addiction is a real thing and if so, whether they should go cold turkey to quit. 

Quitting seems logical solution, given that it is often the advice for someone with drug and alcohol addiction. In this article I am going to break down what sugar addiction is, why you crave sugar and some tips to overcome feeling like you have a sugar addiction.

Firstly, what is addiction?

This is a complex question because the definition of addiction is controversial.

In short, you can have two categories of addiction:

  1. A substance addiction such as drugs, alcohol or tobacco
  2. A non-substance behavioural addiction such as gambling

It has been suggested that some foods with “addictive agents”, such as salt, fat and sugar, could result in people showing the same symptoms as someone with a drug addiction. There has even been media reports suggesting that sugar addiction is a thing, and that it’s as addictive as heroin and cocaine. But the reality is that there are not many studies that have examined sugar addiction specifically in humans – the studies that do exist have been carried out in rodents. 

Sugar addiction – is it the same as being addicted to drugs?

Chances are that you have already googled this. After reading a ton of contradictory information, you may think sugar addiction and drug addiction manifest the same symptoms.

Well let’s look at it in detail.   

If we were to go by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), it diagnoses a Substance Use Disorder (substances such as tobacco, alcohol, drugs) based on 11 symptoms. These can be grouped into four categories:

  • Impaired control: symptoms relate to cravings and a strong desire to use the drug or failed attempts of cutting back on drug use.
  • Social issues: symptoms relate to situations where the person’s work, home and social life is disrupted due to continued drug use.
  • Risky use: symptoms relate to a person’s continued use of the drug despite the known negative consequences.
  • Drug physiological effects: symptoms of tolerance (the body requires more of the drug to produce the same effect) and withdrawal (the body shows withdrawal symptoms when the drug is no longer in the body and a tolerance has developed

So could some of those symptoms occur with a “sugar addiction”? After reading this, you may think so!

For example:

  • Do I have cravings and a strong desire to eat sugary foods? Yes!
  • Have I repeatedly attempted to cut back or “quit” sugar? Yes!
  • Do I feel so “out of control” with food that I’m not in the mood to attend social events? Yes!

But let’s pause for a second. For a substance use disorder diagnosis, the symptoms need to cause “significant impairment or distress”.

And anyone who is experiencing significant distress such as this related to eating patterns, is more than likely going to be diagnosed with an overall eating disorder, which is very different to suggesting that someone is addicted to sugar in the same way that someone is addicted to drugs.

Another key part of a diagnosis, is that the symptoms produce physiological effects. Drug taking can cause people to develop withdrawal and tolerance symptoms. The good news is that there has never been a human study to show that sugar (or any nutrient for that matter, except for caffeine) produces tolerance or withdrawal effects. 

So if “sugar addiction” isn’t a thing, why do I still crave it?

Because

1) Restriction

The root cause of feeling out of control around food is restriction, not food addiction. We know this because as soon as we deprive ourselves from a food, we want the food even more and there a number of studies to support this (see my recent article with the research on how to stop food obsession). We subsequently eat more of it than we would have if we’d just allowed ourselves to eat in the first instance! Following food rules that restricts intake of our “forbidden foods” can lead to excessively focussing on those foods which just exacerbates disordered eating.

You may have heard that in animal studies, sugar is addictive. However, these studies fail to emphasise, that the animals have actually been deprived of sugar. So of course they ended up “bingeing” on it when they were allowed it again. The group of rats that were deprived, actually ate the same amount of sugar in a 12 hour period compared to a group of rats that weren’t deprived over a 24 hour period. What’s the moral here? Eat the sugar!

2) Food is pleasurable (which is not a bad thing!) and needed for survival

Whilst animal studies might show that the brain reacts in a similar way to when drugs are taken, they fail to recognise that food is something that is needed for survival. Sugar is not a drug – it’s the most basic fuel source we need to stay alive! It is therefore supposed to bring joy. Our brain needs glucose to make sure we can carry out all the required biological functions to keep us alive. So how could we be addicted to something that we need to function?

The same centres light up when we have sex, when we stroke a puppy or even when we win or anticipate winning money. Does that mean we are addicted to sex, puppies or money? No.

Where does that leave us?

Studies in this field are still in their infancy, and of the research that does exist, it is limited to animals.

Also, it is difficult to confirm that sugar, as a standalone nutrient, is addictive as we rarely consume this on its own. Sugar is in starchy foods such as potatoes, breads and pastas as well as in fruit, vegetables and dairy products. Things we usually eat in conjunction with many other things!

In saying all of this, I do not want to lessen the struggles that some people may feel they have around food. It is still possible to feel “out of control” around sugar and overeat sugary foods, but it is unlikely to be addiction. It’s more likely to be rooted in restriction.

If you feel this is you, Intuitive Eating is a gentle evidence-based approach that doesn’t require going cold turkey. This framework has helped people reduce overeating or binge eating because it teaches how to identify hunger and fullness signals without restricting food.

Intuitive Eating requires time and patience, but also the right support from someone qualified. A Registered Dietitian and Certified Intuitive Eating Counsellor is a good place to start. If you’d like to know more about what you can start to do today to overcome your difficulties with feeling addicted to sugar, check out my free 20-minute audio download below. 

Please note: if after reading this, you think you might have an eating disorder, I encourage you to visit your GP to discuss this.

References throughout text.  

Why you don’t need to stop eating sugar to improve your health

Why you don’t need to stop eating sugar to improve your health

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Why you don’t need to stop eating sugar to improve your health 

KATHERINE KIMBER, Registered Dietitian

March 3rd 2019

First it was salt. Then fat. Then carbohydrates.  

Now we’re told to stop eating sugar.

All these foods have been demonised at one point or another over the years and we’ve been taught to fear them due to the implications they can have on our health. But sadly, this is more fear mongering, than fact. 

Let’s talk about the facts, specifically regarding sugar.  

Even though some “wellness experts” would have you believe that we need to “stop eating sugar” completely for the sake of our health, it is actually nothing to be feared, unless it is consumed in huge quantities (like anything, really!). 

The problem with the idea that we should “stop eating sugar” is that not all sugars are equal. If we stop eating sugar, we’d be quitting entire food groups and all the important vitamins and minerals found in them! 

Hang on, I thought sugar was bad, because it’s the stuff in cakes, biscuits and sweets, I hear you ask?  

Yes and no.  

Yes, there is sugar in our favourite sweet treats, but this is usually refined sugar (table sugar). Consuming this type of sugar in small amounts is not harmful to our health (1). It is recommended that we consume sweet foods with meals as much as possible to protect our teeth, however, cutting out sugar from our diet all together could backfire and we could end up eating more than desired. Especially in those who want to stop food obsession, or who struggle with binge eating and want to stop emotional eating (2, 3, 4).  

The other type of sugar that shouldn’t be feared, is the naturally occurring sugar found in fruits, vegetables, dairy products and wholegrains. But more about these two things later.   

Let’s first look at what a sugar actually is. I apologise, but there is a little bit of chemistry ahead. 

The chemistry…

A sugar is something that is made up of carbon, hydrogen and oxygen atoms (a sugar molecule). The number of these atoms and how they are arranged, will determine the kind of sugar it is, how it behaves in food and then how it interacts once it is in your body. 

There are many different types of sugars found in foods. 

For example, the sugar found in dairy products (lactose) is different to the sugar in fruit (fructose) – they are completely different sugars and digested in different ways, but they are sugars nonetheless. 

If we were told to quit eating sugar, we’d essentially be eliminating dairy and fruit out of our diets!  

And we’d also be eliminating cereals, pasta and rice … because the complex carbohydrates found in those foods are also made up sugar molecules – lots of them (hence the name “complex”).  

Sugar, at its most basic level, is what our body needs for fuel.

But what about blood sugar levels?

One reason why there is fear surrounding sugar is because of its impact on our Blood Glucose Levels (BGLs). You might have heard someone say “oh don’t eat that, it makes your blood sugar spike”?? This is semi-true. Yes, dramatic spikes in our BGLs can affect our energy levels. Also, eating foods that are high in sugar and low in fibre could cause hunger to reappear more quickly after eating. But this all depends on the type of the sugar that is in the food and what we eat the sugar with (e.g. protein and fats).   

We can measure how quickly a carbohydrate food makes your BGLs rise by using an international standard called the Glycaemic Index (GI) (5). Carbohydrates are rated on a scale between 0 – 100 depending on how quickly the body breaks it down to be used for energy.  

Foods with a higher GI are broken down more quickly and can cause a sharp rise in BGLs – things like a glass of sugary drink on an empty stomach, white bread, white rice and white potatoes. However, who just eats a plate of white rice, or a whole lot of bread without a topping? No judgement if you do, but most of us prefer these with other foods most of the time. We usually eat these foods with some proteins and fats which naturally lower the GI.  

Foods with a low GI number break down more slowly and help to keep your BGLs stable – things like wholegrain bread and pasta, fresh fruit, lentils and legumes, yoghurt and milk. In fact, chocolate is low GI because it contains a high amount of fat and protein… I bet you never realised that!  

So, what’s important is the type of sugar and what we pair it with, to determine its nutritional quality and impact on your body, rather than tarnishing all sugars with the same brush!  

Naturally occurring sugars vs “free sugars”  

Now that we know what a sugar is, we can talk about naturally occurring sugar vs “free sugars”.  

Natural sugars, as the name would suggest, are those already found in the food. These often come with a host of other beneficial nutrients. For example, milk and yoghurt contains the sugar lactose as well as calcium and protein. Fresh fruit contains fructose, as well as vitamin C and fibre.  

So, what exactly are “free sugars”?  

The World Health Organisation (WHO) defines it as those that are added in by either the consumer or the food manufacturer and the sugars naturally found in fruit juice, honey, syrup and fruit juice concentrates. Things like bakery items, cakes, cookies and soft drinks. It also includes the table sugar you add to your coffee in the morning.  

The WHO recommends limiting free sugars to no more than 10% of total daily energy intake (about 10 teaspoons) to reduce the risk of dental carries, chronic disease and poor diet quality (6). 

What about alternative sweeteners then?  

If we’re told that we need to reduce our sugar intake, should we turn to sugar substitutes instead? Well there are loads of sugar alternatives being used, many so that recipes can claim they’re “sugar free”, but it’s difficult to know whether they’re any better than just your regular old table sugar. 

Let’s have a look at some. 

Maple Syrup 

What it is: More commonly used as a weekend breakfast item, but it is also used in recipes as a table sugar replacement. The syrup is formed after the sap is extracted from the wild maple tree and concentrated. 

Nutrients: Contains traces of vitamins and some minerals such as potassium, iron and calcium. 

GI: 54 (7).  

Brown rice malt syrup 

What it is: An expensive replacement often used by people who follow a “sugar free” lifestyle. It is produced by cooking brown rice flour or starch and breaking it down into simpler sugars to produce a liquid.  

Nutrients: It is low in fructose and could be a suitable replacement for people with fructose malabsorption.  

GI: 98 (7)  

Agave syrup 

What it is: A very sweet sugar alternative with minimal impact on BGLs. Processed from the agave plant grown in the south west of the USA and northern parts of South America. 

Nutrients: Is high in fructose, which could cause digestive distress for people with fructose intolerance. Has slightly higher calories than table sugar, 60 calories per tablespoon compared to 40 calories for the same amount of table sugar (8). 

GI: 10 (7).  

Dates 

What it is: A whole fruit  

Nutrients: Contains fibre, potassium (essential for maintaining fluid balance in the body and controlling electrical activity in the heart) and magnesium (essential for proper nerve function, muscle contraction and regulation of blood glucose level and blood pressure) 

GI: 50 (7) 

Stevia 

What it is: Made from the leaves of a native plan in Paraguay in South America, is often used in coffee as a replacement for table sugar in coffee.  

Nutrients: It is much sweeter than table sugar, with negligible calories and does not raise blood sugar.  

GI of 0 

Coconut sugar 

What it is: Made from the sap in the flower buds of a coconut palm. The sap is boiled to allow the water to evaporate and then dried to form a concentrate. It is  

Nutrients: Contains potassium, iron, zinc, and calcium according to research conducted by the Philippines Government research body, but you need to eat a lot to make a difference (9). It also contains the same number of calories as white sugar. 

GI: low GI of 54 (7) 

So, while there are many pros and cons on just this short list of the many alternatives that are available, the reality is that they are all still sugars and most of them contain energy, with little vitamin or minerals (10). And whilst sweeteners are low in calories, there is some evidence that sweeteners may actually increase our appetite (11). 

Summary

So, with all the scaremongering around sugar being harmful, the reality is that a diet that has a limited intake of sugar (whatever sugar that may be) is not harmful for a healthy individual.  

There are many foods with naturally occurring sugars that contain nutrients that are highly beneficial, so let’s not go cutting those just yet.

And then as for those free sugars which have little nutritive value? Well, a little bit of honey on toast or glazed on roast carrots can fit into a healthy diet. These foods are there for the enjoyment and satisfaction of eating and cutting them out completely could backfire and result in food obsession and binge eating. After all, who was it that once said a spoonful of sugar helps the medicine go down?   

Note: this article is not designed to replace individual advice from your healthcare provider.  

References 

  1. The British Dietetics Association. (2017). Sugar. Retrieved from https://www.bda.uk.com/foodfacts/sugar. Accessed on 1/03/2019.  

2. Keeler, Chelsey L., Richard D. Mattes, and Sze‐Yen Tan. “Anticipatory and reactive responses to chocolate restriction in frequent chocolate consumers.” Obesity 23.6 (2015): 1130-1135. 

3. Konttinen H, Haukkala A, Sarlio-Lahteenkorva S, Silventoinen K, Jousilahti P. Eating styles, self-control and obesity indicators. The moderating role of obesity status and dieting history on restrained eating. Appetite (2009): 53:131–4.  

4. Jansen, Esther, et al. “From the Garden of Eden to the land of plenty: Restriction of fruit and sweets intake leads to increased fruit and sweets consumption in children.” Appetite 51.3 (2008): 570-575.

5. International Organisation for Standardisation (2010). Food products — Determination of the glycaemic index (GI) and recommendation for food classification. Retrieved from https://www.iso.org/obp/ui/#iso:std:iso:26642:ed-1:v1:en. Accessed on 1/03/2019.  

6. WHO. (2015). Sugar intakes of Adults and Children. Retrieved from. https://www.who.int/nutrition/publications/guidelines/sugars_intake/en/. Accessed on 3/03/2019. 

7. The University of Sydney. (2017). Search for the Glycemic Index. Retrieved from http://www.glycemicindex.com/foodSearch.php. Accessed on 1/03/2019.  

8. Web MD. (2014). Agave: Calories, Nutrition Facts, and More. Retrieved from https://www.webmd.com/diet/features/the-truth-about-agave#1. Accessed on 1/03/2019.  

9. Medical News Today. (2018). Coconut sugar. Is it good for you? Retrieved from https://www.medicalnewstoday.com/articles/323047.php. Accessed on 1/03/2019. 

10. NHS Choices. (2016). Are sweeteners safe? Retrieved from https://www.nhs.uk/live-well/eat-well/are-sweeteners-safe/. Accessed on 1/03/2019.  

11. Web MD. (2018). Is there such a thing as healthy sugar? Retrieved from  https://blogs.webmd.com/food-fitness/20181004/is-there-such-thing-as-healthy-sugar. Accessed on 1/03/2019.  

Additives and Preservatives – Are They Really That Bad?

Additives and Preservatives – Are They Really That Bad?

RELATIONSHIP WITH FOOD

Additives and Preservatives – Are They Really That Bad?

KATHERINE KIMBER, Registered Dietitian

February 19th 2019

Often, we hear that we should avoid all foods with additives and preservatives (aka chemicals). 

Let’s be clear. This is virtually impossible, because: 

a) all food contains chemicals

b) we as humans are made entirely of chemicals; and

c) we require chemicals to function! In fact, our very existence is due to thousands upon thousands of chemical reactions happening inside us right now which … you guessed it, need specific chemicals from food to be able to happen!  

So, let’s look at exactly what the chemicals are in food and try to strip the nonsense.  

Firstly, there are naturally occurring chemicals in food, such as vitamins and minerals.  

Secondly, there are synthetic chemicals made in a lab – these are often the additives and/preservatives we find in food. 

We often fell that we should avoid additives and preservatives… particularly those ingredients with long scientific names that you can’t pronounce.  

If we did that, then we’d be missing out on a lot of foods, or our foods just wouldn’t taste so great (as outlined in the image below).

Let’s look at some examples…

  • Take for example tocopherols and ascorbic acid (I.e. 3001, E3002, E3004) – if you saw these listed in the ingredients, what would your reaction be? They sound scary (particularly as one contains acid!) but in actual fact, these are just the chemical names for Vitamin E and Vitamin C which are commonly added to foods to help prevent microbial growth, and keep foods fresh, free from spoilage.  
  • Citric acid also sounds like one to avoid, but it is naturally found in citrus fruits and berries and used as a tart flavouring and decrease enzymatic browning of fruit. 
  • Now what about polyethylene and beeswax? Would you still eat something with these two ingredients? Well, these are used as edible coatings on fruit and vegetables to increase shelf life (1). 
  • What about guar gum, xanthan gum or pectin? Would you eat those? These three chemicals are stabilisers used in cloudy fruit juice beverages to stop pulp settling at the bottom of the bottle (2).  
  • Lactic acid also sounds pretty scary, but it is simply the by–product of corn or cane sugar being fermented and it is used to add tang to frozen desserts or fruit drinks.  
  • There is a lot of negative hype around emulsifiers too, which is a substance used in foods like almond milk, ice-cream, mayonnaise, and salad dressings. It essentially stops the oil from separating so we can enjoy these wonderful foods! There are some studies conducted in mice that suggest the consumption of these could be linked with gut inflammation and the development of inflammatory bowel disease (3, 4, 5). However, we don’t have sound human studies to support these claims. More studies are currently underway in this space, and in particular, links between the gut bacteria and additives and preservatives. Based on the most up-to-date research, the Food Standards Agency (who are responsible for food safety and hygiene in the UK) deem emulsifiers safe in healthy individuals.  

Now as for whether additives and preservatives are harmful or cause disease, it’s important to consider the amount consumed.  

Additives and preservatives are used in food production, but they are used at levels that are safe for human consumption. Having too much of anything is not good, for example dihydrogen monodioxide (aka water) is harmful in high levels and so too is sodium chloride (aka table salt).  

The only additives for which evidence has shown a link with cancer are nitrites and nitrates, which are used as preservatives in processed meat such as ham, bacon and chorizo. Eating processed meat is strongly associated with an increased risk of bowel and stomach cancer (6), (7).  

So, it’s all about the quantity. That is why the amount of additives used in food is tightly regulated by the Food Standards Agency. Also, any additive must be listed in the ingredients list (in decreasing order of weight) if it performs a function, such as giving food its colour or preserves its shelf life.  

Foods contain lots of additives and preservatives for a variety of reasons. They can come both naturally and synthetically and are not only important for killing or slowing down the growth of harmful bacteria, but can also act as a gelling agent, a thickener, a shortener, an emulsifier, a sweetener, yeast food… the list is endless (8).  

So, should you still eat foods with additives and preservatives?  

As it is all about the quantity consumed, it’s important to look at your overall dietary quality. If you have a diet high in processed foods that use a lot of additives and preservatives, then you may be missing out on fresh fruit and vegetables or fresh whole grains that are full of important vitamins and minerals.  

However, if you use a jar of stir-in pasta sauce with a pot full of fresh vegetables and wholegrain pasta, then this small amount of additives in the sauce jar will not be an issue.  

Essentially, unless you only eat fruit or vegetables that have been picked fresh, you’ll most likely be consuming foods with additives and preservatives. It’s about considering your overall dietary pattern and striking a balance between consumption of fresh produce and processed products. You can have your apple as well as your apple cake.  

References 

(1) Ruelas-Chacon, X., Contreras-Esquivel, J. C., Montañez, J., Aguilera-Carbo, A. F., Reyes-Vega, M. L., Peralta-Rodriguez, R. D., & Sanchéz-Brambila, G. (2017). Guar Gum as an Edible Coating for Enhancing Shelf-Life and Improving Postharvest Quality of Roma Tomato (Solanum lycopersicum L.). Journal of Food Quality, 2017, 1-9. doi:10.1155/2017/8608304 

(2) Ashurst, P., Hargitt, R., & Palmer, F. (2017). Soft Drink and Fruit Juice Problems Solved. Cambridgeshire, England: Woodhead Publishing. 

(3) Chassaing, B., Koren, O., Goodrich, J. K., Poole, A. C., Srinivasan, S., Ley, R. E., & Gewirtz, A. T. (2015). Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome. Nature, 519(7541), 92.

(4)  Bhattacharyya, S., Shumard, T., Xie, H., Dodda, A., Varady, K. A., Feferman, L., … & Tobacman, J. K. (2017). A randomized trial of the effects of the no-carrageenan diet on ulcerative colitis disease activity. Nutrition and healthy aging, 4(2), 181-192.

(5) Levine, A., Boneh, R. S., & Wine, E. (2018). Evolving role of diet in the pathogenesis and treatment of inflammatory bowel diseases. Gut, 67(9), 1726-1738.

(6) World Cancer Research Fund. Colorectal (bowel) cancer. 2011. 

(7) World Cancer Research Fund. Stomach cancer. 2016. 

(8) Food Standards Agency,  Food Additives, 9th January 2018, [Accessed on 19th February 2019], retrieved from  https://www.food.gov.uk/safety-hygiene/food-additives.   

Links to further resources: