Sugar Sickness

2021 Top Story in Primary Care: Sugar Sickness

Recent story about “Sugar Sickness”

Written by

 David Rakel MD, FAAFP



Glycemic Index and Glycemic Load

In 1999, The Glucose Revolution was published, opening our awareness of the importance of glycemic index and glycemic load. After 22 years, research has accumulated supporting its claims, and many of these studies were published in 2021.

The glycemic index is a rating of how fast sugar from a food is absorbed into the blood stream. Glycemic load considers the amount of sugar consumed. For example, watermelon has sugar with a high glycemic index (72), but most of watermelon is water. Although watermelon has a high glycemic index, you would have to eat about three watermelons to consume enough sugar for a high glycemic load.

Foods that have a high glycemic index and a high glycemic load pack a lot of sugar into a small package, like chocolate cake, juices, processed foods, and fluffy white bread. In fact, fluffy white bread is given a glycemic index of 100, the maximum score for the glycemic index “bread” scale. Fluffy white bread is like cotton candy. It is made from bleached white flour (sugar) without fiber and is absorbed into the blood stream very quickly. You can also assess the glycemic index of bread by squishing it in your fist to make a ball. The smaller the ball, the more sugar, and less fiber—like cotton candy.

A review of key studies from 2021

  • The PURE Study followed 137,851 people across diverse geographic and economic countries over 9.5 years. Those in the highest glycemic index group had a hazard ratio of 1.51 for major cardiovascular events and death.1
  • The Framingham Offspring cohort was followed for 18 years, comparing those who ate the most processed foods with those who ate the least. Those in highest compared with the lowest quartile had twice the incidence of a cardiovascular event. A high glycemic index sugar was the number-one predictor of mortality in the participants who consumed a high processed food diet.2
  • One of the most inflammatory components of the diet is excess sugar. When sugar is quickly absorbed into the blood stream, insulin is released. When this happens repetitively, insulin resistance occurs, perpetuating inflammation and weight gain. The Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) found that the highest tertile of a diet rich in sugar, alcohol, and red and processed meat was associated with a three times higher risk of dementia compared with the lowest tertile.3
  • The best predictor of a high sugar diet is a high triglyceride (TG) level. The Progression of Early Subclinical Atherosclerosis (PRESA) study evaluated a subset of 3754 individuals at a low to moderate risk for cardiovascular disease. The main take-home message of this study was that a TG level >150 mg/dL was independently associated with plaque and vascular inflammation even with a normal LDL cholesterol level.4 High TG is also a predictor of fatty liver disease, which recently surpassed infectious hepatitis as the second leading cause of cirrhosis in America after alcohol. Fatty liver is mainly a disease of too much sugar.
  • The British Medical Journal published a paper by Taylor on how type II diabetes can be reversed, even 10 years after diagnosis, if one is able to maintain weight loss on a low-carbohydrate (glycemic index) diet.5 Ludwig followed with a paper suggesting that a high glycemic load diet over time explains hormonal triggers that support the perpetuation of obesity. He coined this the carbohydrate–insulin model.6

In the 1950s we became fearful of fatty foods as we opened the human body, finding saturated fat clogging the arteries. The pendulum then shifted away from high-fat foods, which were replaced with sugar. The pendulum needs to swing back to the middle where we consume less sugar, with most carbohydrates coming from fiber-rich whole plants. Although research is slow to prove causation, we can apply this science now for a healthier 2022.

Categories: Lifestyle