Episode 84: Sugar – the Sweet and the Sour (Part 2)

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Welcome to Supplementing Health, a podcast presented by Advanced Orthomolecular Research. We are all about applying evidence based and effective dietary lifestyle and natural health product strategies for your optimal health. In each episode, we will feature very engaging clinicians and experts from the world of functional and naturopathic medicine to help achieve our mission to empower people to lead their best lives naturally.

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[01:07] Cassy Price: Hello. Thanks for tuning in to Supplementing Health. Today we are excited to be welcoming back Dr. NavNirat Nibber, naturopathic doctor, to continue our conversation on the impact of sugar in our long term health. Hey NavNirat, welcome back.

[01:20] Dr. NavNirat Nibber: Hi. Thanks for having me.

[01:22] Cassy Price: Last week we left off talking about how artificial sweeteners play into insulin resistance and the pathways in our brain that lead to sugar cravings and maybe lack of satiety when it comes to how full we feel after eating some of these foods. Some researchers have speculated that artificial sweeteners such as aspartame could be toxic to the brain as they increase inflammation. What is your take on this piece around the inflammation that is caused by them?

[01:51] Dr. NavNirat Nibber: This is an area that, again, I think we are still learning about, but the impact again is more that we are activating some of these pathways. And anytime you flood with too much sweetness or you are activating too much of those reward pathways, you can induce some inflammation there because your body still has to manage and mitigate the excess fuel source that is coming in all of a sudden. You do get risk for things like advanced glycated end products, called AGEs, which can induce oxidative stress and inflammation. You can see that there is this huge cascade that we can start going down. There is concern for some of these alternatives, which actually were touted as an alternative for sugar but maybe they are not what they need to be. Which is why sometimes people who are solely consuming diet coke are still getting some of those adverse negative health benefits. Let’s just limit total consumption and replace our diet coke with water or flavoured fruit water. We need to become really mindful. We don’t want to be duped into thinking that just because it is an artificial sweetener or low-calorie sweetener, low fat – is still a big area of concern because they compensate with so much more sugar. I think I am digressing. Ultimately, yes, there is this risk that it could be toxic and that exact pathway we are still elucidating.

[03:42] Cassy Price: Too much excess sugar can also create inflammation in the body, can it not?

[03:47] Dr. NavNirat Nibber: Yes, when we are talking about those added sugars, that is part of why it is so bad to consume so much of these high-fructose corn syrups, the sucrose, the added table sugar, because it does increase that inflammation in the body. What it is doing is you are activating this – there is too much that can’t be taken up in the cell. It is sitting around either in the blood stream or in the gut and can actually cause an inflammatory cascade. Then you are just sitting in this toxic soup of inflammation. What that can also do, it is almost like you have ramped up production too fast and you are creating all of these toxic byproducts or reactive oxygenated species in the cells. It is almost like a kitchen that isn’t properly ventilated and all of the smoke starts filling up. That is where we start to get a lot of that damage and inflammation in the gut, damage to cells which is those reactive oxygenated species. Then again, because you have excess sugar molecules they start attaching onto proteins and then you get these things called advanced glycated end products. When you have attached that sugar to that protein it bulks it up, anywhere it goes you have now restricted that movement of that protein. It is kind of like clogging up the drain. You see this a lot with cataracts in the eye. They get advanced glycated end products, so part of why a lot of diabetics get cataracts is because these sugar molecules are attaching onto the proteins, and we need something to come and clip it off.

[05:47] Cassy Price: Speaking of the inflammation in the gut and how that plays into irritable bowel syndrome and other inflammatory conditions, how does that impact those conditions specifically? Is that usually a trigger or is it something that can then add to an already existing condition? How does that play into that?

[06:18] Dr. NavNirat Nibber: Like everything I’ve said today it is a complex process, where it is kind of a chicken and the egg. Certainly, we know that excess sugar consumption will exacerbate an inflammation and it can induce, but it is interesting to see the etiology of what happens first. I think a big piece that we need to also bring into this discussion is the role of the microbiome and gut health. We know these good bacteria are often protective, they help us to metabolise, break down our nutrients and with absorption. Basically, our microbiome is the GOAT, it is very important and we should not overlook it. Sugars, we know, do impact the makeup of this microbiome. We know that sugars will preferentially feed certain types of bacteria and it does shift the makeup of our microbiome because these act as prebiotics. If you are having excessive amounts, if you are basically feeding the types of bacteria that you don’t want or in so doing, they are creating a lot of byproducts of the bacterial metabolism, then our bodies have to take that on as well. This could also be, this is kind of the working hypothesis right now for why sugars are really inflammatory for particularly things like IBS or colitis, because you are actually shifting and throwing off your microbiome.

[08:10] Cassy Price: Is there a link between the type of bacteria that is in someone’s microbiome and the propensity towards insulin resistance?

[08:25] Dr. NavNirat Nibber: Yes. That is a really interesting – probably for gastroenterologists that is the million-dollar question, for anyone supplementing probiotics or creating probiotics. There is a lot, that the strains we use, the dosages of those strains that we use, there is a lot coming out on which of those strains are really important. I don’t know if we have the time to go into each of them but strains like Bifidobacterium longum BB536, that is a strain I know that is really being well characterised and understood for promoting gut health and also promoting the formation of short chain fatty acids. Short chain fatty acids will help. They are produced by the bacteria and those can help fortify the cells and offset some of the response to the sugar. Those are the strains that you obviously want to promote and propagate and then those bad strains, if you will. It is called dysbiosis, so it’s how much more of those are growing and where are they growing? Have they migrated up to the small intestine or are they staying in the lower intestine? I do see a lot more understanding and a lot more research coming out. There are papers and papers and papers related to this, so I do think we will probably be able to start characterising those specific strains and then also our genetic propensity or response to certain strains. That is all coming out because we have access now to genetic testing and microbiome analysis through stool testing. We have all of these tools. I do think that will probably become much more clear than this answer which I am giving you which is; yeah, we know there is a link there, we are still trying to characterize and identify exactly what that link is.

[10:55] Cassy Price: Then the other piece of that that I was wondering about, I know butyrate is a short chain fatty acid that has been getting a lot of love over the last few years, as far as all the good that it does for our body. Does it have a role in reducing insulin resistance or improving those sugar cravings, that sugar utilisation picture?

[11:17] Dr. NavNirat Nibber: Yes. Absolutely. They are looking at short chain fatty acids as a group, and butyrate in particular, as one – fortifying the first point of entry for a lot of those sugars, those intestinal cells, those enterocytes. The more you fortify them the more you strengthen that ability to restrict access or free flow of sugar or fructose into the cell, the more you are going to be able to then prevent it from going into the blood stream and that hormone response from the pancreas. What is really exciting is that these short chain fatty acids are being examined as therapies for individuals who either have some dysbiosis or blood sugar dysregulation, and I think it is going to be really exciting to see in the next few years how much more we’re going to be able to utilise that. It is also really going to be helpful in ensuring that we have healthy blood flow and cardiovascular flow, because in an indirect way, because we are reducing some of that inflammation and oxidative pressure that arises from that inflammation of having damaged enterocytes. Butyrate and short chain fatty acids are going to be really good. It also helps with bloat and acts as, basically, like a really good fibre, so we are going to see more cholesterol reductions and management to offload some of that burden on the liver.

[13:16] Cassy Price: Okay, in the vein of cardiovascular health, pun intended, there is a 2014 study that found an association between high sugar diets and a greater risk of dying from heart disease. I think the study was done over 15 years and people that had 17-21% of their calories from added sugar had a 38% higher risk of dying from CVD compared to those who consumed 8% or less of their calories from added sugar. You talked a little bit about how people should be aiming for 5% of their calorie intake to be from sugar. Can you explain that mechanism of action that is playing into heart health in particular here?

[14:03] Dr. NavNirat Nibber: What is really interesting about this is it can be related to our processes. Our nitric oxide production, nitric oxide is a small molecule that is transiently produced and helps essentially with blood flow so vasodilation and helps improve that blood flow. To do that you need plasticity or you need your arteries and blood vessels to be able to expand and contract as needed. Nitric oxide basically helps with this through different pathways. What sugar can do is block some of those pathways and block some of that production. We are actually seeing that the vessels themselves are less responsive and then it is almost like you start getting that hardening. If you get a hardening, then you’re at risk because you are not getting the proper oxygen to the tissues and you are at risk for a cardiovascular incident. That is one aspect. Then we do know that the sugar itself, as I mentioned, can increase just specific oxidative stress in tissues and that includes the heart. It can induce some of that stress on the heart, cells themselves, and that again can increase inflammation to that area and then you are left with another cardiovascular incident. The third way is related to liver function and cholesterol management. This is more related to those high fructose sugars. It gets processed like I mentioned in the liver and metabolised in the liver and when you get a backlog of that, you are basically jamming up the whole system and that can also lead to excess cholesterol or reduced cholesterol clearance. When you have high cholesterol that is when we are getting those deposits in the arteries, and we get these plaque formations. It is really important to recognise that while maybe it is not the most direct, it is impacting very important pathways related to cardiovascular function. It is very important that we start being more mindful of that. That is also why things like the Mediterranean diet are considered so beneficial in cardiovascular disease, but you will notice the Mediterranean diet is lots of natural foods and not as much processed foods. So, less sugar. There isn’t a lot of sugar in the Mediterranean type or the DASH type diet.

[17:13] Cassy Price: That makes sense. We do know that nutrients and minerals work synergistically to perform various tasks in the body, so it would make sense that if we are introducing an overload of something that really doesn’t have a ton of nutritional value, or it has been stripped down to one little piece, like added sugar often is, that it would have all of these varying effects on the body. In that same realm of thinking, are there any nutrients that impact the way that sugar is utilised? That if we are consuming sugar, that when we eat it with these different nutrients it actually makes it better for us?

[17:56] Dr. NavNirat Nibber: It does make a difference what we are consuming the sugar with. That is why fruit as a whole fruit is very different to fruit as a fruit juice. I think it comes down to three things. One is fibre. Fibre. Fibre. Fibre. Fibre. I am a big fan of fibre and I think we all need to be consuming more. What fibre does is essentially locks into a matrix of sugars. Again, we get this slower infusion. You will notice when we go back to the glycemic index or glycemic load, those foods with higher fibre content intrinsically have a bit of a lower glycemic index because again, you are not flooding the system too fast. You can slowly infuse that. Another important aspect of that is what are the other things, whether they are antioxidants, polyphenols, flavonoids that are actually able to offset and reduce some of the negative impact that you would have from too much sugar, because again, that is going to mitigate some of the risk of the sugars. Those really brightly coloured fruits, blueberries, they are antioxidant rich so those are going to help mitigate that. In terms of nutrients themselves, we know that things like chromium could be really helpful for that. Sometimes if we are looking at the reward pathways for those sugar cravings, like we talked about earlier, those are dopamine mediated so it could also be in relation to making sure you are getting B vitamins and all of the precursors to dopamine so that you are able to mount proper responses. That can also be related to proper sugar management. Then making sure you have a good microbiome. Basically eat, move, sleep well, rest. 

[20:35] Cassy Price: All of the generic recommendations that we hear.

[20:41] Dr. NavNirat Nibber: It always seems so reductionist. Just be healthy. But how?

[20:47] Cassy Price: Are there certain deficiencies that sugar cravings can be indicative of?

[20:54] Dr. NavNirat Nibber: Yes, there’s a few it could be related to. If you are really craving those dark chocolates that could be more related to magnesium. A sugar craving could be indicative of some insulin resistance building. It can also be related to cortisol dysregulation. We haven’t talked about this too much but the stress response, sometimes when we have an elevated stress response the cortisol is mismanaged and that can increase our desire to get fuel and so our body is saying “get me some sugars, I need energy fast.” That is the fastest way to get it. Cortisol dysregulation can also be a big part of that.

[21:49] Cassy Price: Cortisol as we know is a hormone which also makes me think about our other hormone profiles that get affected by what we eat and whatnot. PCOS is a hormonal condition that is often associated with insulin resistance. Why is that?

[22:11] Dr. NavNirat Nibber: PCOS is a condition that exists on a spectrum. There is a strong link with insulin resistance, but it is actually related back to our sex hormone function, our estrogen, progesterone levels and fat cells. It is very complex. PCOS is this complex interplay between our blood sugars, our sex hormones and then just our general lifestyle. It is really hard to pinpoint exactly where it is coming from, but we do know that there is a connection and those who start to exhibit things like very high free fatty acids in the blood, so high triglycerides, maybe abnormal insulin so fasting insulin will be off, often do also have this correlation between their estrogen, progesterone pathways are a little bit off. What can happen is, this can both be related to weight gain and it can exacerbate weight gain. In fat cells that estrogen is cyclising and when it cyclises in the fat cell it also turns into testosterone, so then you get this elevation of androgens and that is when we see things like cystic acne, coarse hair growth on the face for women. We are combining now the endocrine function as well as food. Those who are on low sugar diets do seem to benefit because you are recorrecting that insulin management and it is having a positive effect on both shrinking the fat cells, so there is less estrogen cyclising, but then it is also helping manage your estrogen output by both the ovaries and then from the higher central nervous system perspective.

[24:49] Cassy Price: Would PMS cravings have a similar underlying cause then?

[24:59] Dr. NavNirat Nibber: Yes, in that it is often related to that fluctuation with estrogen. Sometimes we do see with more estrogen dominant conditions, so when you have too much estrogen and you are not getting that proper decline before your period, it can be more associated with blood sugar dysregulation. It can be that you are more craving sugars.

[25:33] Cassy Price: If people are suffering from those cravings particularly around their cycle or from hormonal imbalances, what are some of the things they can do to manage those cravings while addressing that underlying root cause?

[25:50] Dr. NavNirat Nibber: Of course, while you are addressing the estrogen progesterone ratios and the cortisol for stress, certainly engaging in both regular exercise because that is the fastest and most well described way to mitigate and reduce the impacts of insulin resistance. Because now you are basically repurposing that fuel source and your body responds accordingly. Exercise as much as you can, just get moving. The second thing, again, would be to eat a high fibre, nutrient rich, low processed food diet. That will influence your hormones as well. Part of that is making sure that sugars are paired with proteins, so that you are not just eating sugars alone and flooding the system. Again, that is where a healthy plate comes in. Make sure that you have vegetables on your plate, healthy fats on your plate and that you have very rich fibrous foods on your plate for every meal.

[27:14] Cassy Price: The other thing that comes to mind when you think hormonal imbalance and PMS is often acne. Everyone dreads acne. Lots of people suffer from it. We know there are many factors that play into skin health, not just hormones but inflammation as well. Knowing that sugar can impact both of those hormone profiles as well as overall body inflammation, how do you determine when skin conditions, such as acne, are due purely to poor diet or excess sugar consumption rather than other potential underlying causes?

[27:53] Dr. NavNirat Nibber: We always want to do a thorough intake when we are assessing what someone’s dietary habits are like. We are also looking at if they are experiencing any menstrual irregularities and things like that. That can help guide us. Also, the type of acne. If it is more cystic acne, then we can start thinking in the realm of hormonal mismanagement. We can also do something very simple which is cut out sugar and see if there is a response. It tends to respond quite quickly. Within two weeks of cutting out added sugars from the diet people start to see changes. It is a simple, quick test to assess if it really is that sugar. Then because there is such a strong link between our sugar consumption and our gut health and gut inflammation, and skin is the canary in the mine if something is wrong with our gut, again there tends to be this cascade effect where everything clears up magically. If we know that, we can start to work backwards. I think as NDs we are always trying to assess that deeper root cause, whether that is additional lab testing we are doing, whether we are still engaging in specialised testing, that is always important. Sometimes just removal of that is the easiest test we can do.

[29:44] Cassy Price: It’s a safe one people can do on their own, correct? There are no real concerns with cutting sugar out of the diet that you would be lacking certain nutrients or anything.

[29:53] Dr. NavNirat Nibber: Yes. We don’t want to be calorically restricting to the point – we are talking about added sugars. Reducing those to safe levels, you can absolutely do it at home without anybody needing to monitor that.  

[30:11] Cassy Price: Earlier or it could have been last episode, you were talking about advanced glycation end products and those can play a big role in aging and the signs of aging in the skin, can they not?

[30:24] Dr. NavNirat Nibber: Absolutely. Yes, the wrinkling, the sunspots, or those liver spots or darker hyperpigmentation can all be related to those AGEs.

[30:40] Cassy Price: Eating sugars with fibre and protein reduces the likelihood of those AGEs or is that something that will happen no matter what and it is more about the detoxification process?

[30:54] Dr. NavNirat Nibber: I would say that it is more about the detoxification process, but certainly when we eat the fibres and the proteins, we are allowing our bodies to process those sugars and excrete it in a timely manner, so they are kind of one and the same. Also, if someone has a propensity to forming these advanced glycated end products, then like I said, you need something to come and clip off those sugars. That is where a lot of the antioxidants, a lot of the beneficial nutrients in a lot of the whole foods that we eat come in and can actually do that for us. We already get that from foods. For example, when you consume green tea. Green tea is a really great source of catechins, epicatechins and they are really helpful in reducing some of the damage from AGEs and from reactive oxygenated species. It works on two levels. Yes, definitely, how we are consuming sugar, when we consume it – if we can start to consume it with things, that for thousands of years a lot of people have been consuming, things like green tea, camomile tea, even curcumin from turmeric. Turmeric is known to be really helpful for that. Guava leaf and guava fruits help. There is a lot naturally that we have been consuming that already helps reduce that.

[32:52] Cassy Price: This is such an interesting topic. I think even though we have continued this conversation for a second episode we are still skimming the surface. We could do a deep dive almost into each of these subtopics that we have touched on but, unfortunately, we have again hit the end of our time. If any of our listeners want to learn more from you, they can actually check out AOR’s blog which is at AOR.ca as well as check out our bimonthly publication of Health Beat where you often write different articles on various topics as well.

[33:31] Dr. NavNirat Nibber: Yes. Thank you so much for having me. It’s an exciting topic. I know so many of my answers were “well it depends” but, isn’t that the nature of the human body?

[33:44] Cassy Price: It truly is and science too, right? We don’t always get a concrete black and white answer in this field.

[33:53] Dr. NavNirat Nibber: It is always changing, it’s so dynamic. Thank you so much. This has been great.

[33:59] Cassy Price: Thank you as always. It has been a pleasure.  

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