Healthy Life Articles
Fructose and Diabetes: What is the Link?
There has been a lot of recent discussion regarding the link between sugar and diabetes, with fructose in particular being singled out. As a result, in this article we'll investigate the links between fructose and metabolic conditions such as diabetes, allowing you to better understand the problem and the best ways to keep yourself healthy. What is Fructose? Fructose is a monosaccharide (single sugar) that is found in fruits and some vegetables. However, it is also found in sucrose – better known as table sugar. Fructose is also found in large concentrations in high fructose corn syrup, a highly processed sweetening agent used in many western countries. Consequently, the majority of dietary fructose comes not from fruit and vegetables but from added sugars, which provide substantial calories, whilst being totally devoid of nutrients. As with many topics in nutritional science it can be difficult to conclusively answer whether fructose is good or bad for your health. Let's examine the evidence from both camps, allowing us to make some more informed decision about the likely impacts of a high-fructose diet. The Argument That Fructose Is Benign Fructose has quite a low glycaemic index, meaning that it does not rapidly increase blood glucose levels compared to other sugars. Moreover, as it is sweeter than glucose, less of it is required to have the desired effect. For this reason it was once thought that fructose represented a valuable sweetening agent to replace other sugars, especially for diabetics. The Argument That Fructose Is Harmful Sadly, the basic biochemistry discussed above doesn't paint the whole picture. There is growing evidence to suggest that an excessive fructose intake has the potential to negatively impact metabolic health in a number of ways. Appetite It is well documented that a hormone called leptin is released by the body when insulin levels are high. Leptin, which is stored in fat cells, can be thought of as like a thermostat for the body. When leptin levels are low (indicating lower body fat), we become hungrier and eat more. Conversely, when leptin levels are high (indicating higher body fat) we don't feel as hungry, therefore we eat less. Sadly, the minimal insulin increase caused by the consumption of fructose can therefore suppress leptin levels, encouraging us to consume more calories. This viewpoint is further supported by evidence suggesting that around 90% of Type 2 diabetics are either overweight or obese. Although there are numerous other ways to maintain a healthy appetite, it is fair to assume that cutting out added sugars (that are high in fructose) can be very beneficial. Although it would be premature to suggest that fructose has a causal role in the obesity pandemic, scientists note how the rise in fructose consumption mirrors the rise in obesity rates over the last few decades. Fructose and the Liver An even bigger problem with excess fructose is how it is metabolised. Unlike glucose, which can be used by every cell of your body for energy, fructose can only be metabolised by the liver. The rise of added sugar in the typical western diet in recent decades has led to a massive increase in the amount of fructose we consume. Not only this, but some food items like fizzy drinks have also increased the speed at which fructose gets into the system, putting further strain on the liver. It gets worse. In those who have a chronically high intake of fructose, the body actually adapts by digesting and absorbing fructose more efficiently, which can cause more issues. Your body has the capacity to store sugars in the form of glycogen, with around 400g being stored in the muscles, and around 100g in the liver. Once the liver is saturated with glycogen, any excess sugar is turned into fat that is either stored in the liver, or is transported away in the form of triglycerides. And by the way, high triglycerides levels are a risk factor for developing heart disease. The creation of fat from carbohydrates is something known to scientists as de novo lipogenesis, or DNL for short. As this process happens in the liver, it should come as no surprise that a high fructose intake can lead to an increase in liver fat (hepatic steatosis). Once fat in the liver exceeds 5% of its total mass, a physician will give the diagnosis of non-alcoholic fatty liver disease (NAFLD). Alarmingly, recent scientific evidence has estimated that NAFLD affects a quarter of the world's adult population. This condition not only increases the risk of heart disease but a whole host of metabolic diseases such as type 2 diabetes. The link between NAFLD and type 2 diabetes is due to insulin resistance. Research has shown that the higher the amount of fat in the liver, the more insulin is needed to shuttle glucose in. Because of this, the pancreas has to work harder to create more insulin and higher insulin results in a greater resistance. This is a vicious cycle which can continue for years until the pancreas fails, as it is simply unable to meet the demands for insulin anymore. Inevitably, this leads to blood sugar levels sky rocketing. In short, when liver homeostasis is disrupted, so too is metabolic health. How to Spot NAFLD As NAFLD can precede diabetes and other metabolic complications by numerous years, it is important to tackle this issue to regain control of your health. Unfortunately, as we discovered earlier, a significant proportion of adults are walking round with a fatty liver, and most don't even know it. This is one of the reasons why Type 2 diabetes is predicted to affect 642 million people within a generation. One tell-tale sign of NAFLD is ‘central obesity' that is characterised by a large waist circumference. Interestingly, waist circumference is now seen as a more valid indicator of metabolic health than body mass index (BMI). This is for a couple of reasons. Firstly, BMI only accounts for mass, and doesn't differentiate between lean mass and fat mass. More importantly, two people with the same BMI could have very different metabolic profiles due to where they store their fat. Subcutaneous fat (fat under the skin), although cosmetically unpleasant, has a surprisingly innocuous effect on metabolic health. The same cannot be said for visceral fat that cakes organs such as the liver and pancreas. Measuring your waist circumference provides a clearer indication of the level of visceral fat, and therefore metabolic health, when compared to BMI. As we touched on earlier, 90% of those with type 2 diabetes are classed as overweight or obese. But what about the other 10%? Unfortunately for these individuals, the relatively small amount of fat that they store is mostly found around the organs, which is a key contributing factor. So then, what defines a healthy waist circumference that we should all be aiming for? The Dieticians of Canada recommend that men should aim for below 36inches (90cm) and women fewer than 32 inches (80cm). Anything above these measurements is classed as ‘central obesity' and sets people up for numerous health issues. Other Health Complications from a High Fructose Intake While metabolic disease is arguably the most pressing health condition linked to excessive fructose intake it is far from the only potential complication. Studies have shown that ingesting large amounts of fructose in the form of fizzy drinks can rapidly increase the amount of uric acid in the blood. Uric acid is a substance that triggers the formation of painful crystals within the joints – a condition known as gout. Shockingly, research from 2008 showed that men who consumed two sugar sweetened drinks per day were 85% more likely to develop gout than those who consumed the same amount but over the period of a month. We have already discussed how excessive fructose intake increases liver fat and blood triglyceride levels. However, high amounts of dietary fructose can also increase the production of free radicals; harmful molecules that contribute to the ‘oxidative stress' on the cells which can cause inflammation, damage and premature aging. Is Fruit Bad for Me? We've seen that fruit is high in fructose, and that fructose is linked to type 2 diabetes and other metabolic conditions. So the obvious question is whether fruit is actually bad for you? Fortunately, as most fruit is high in fibre, this results in a steady influx of natural fructose to the liver – a situation that is manageable. Moreover, fruit contains vitamins, minerals and polyphenolic compounds which make it a healthy addition to the diet. A century ago, the average person was consuming 15-25g of fructose per day, with most, if not all, coming from natural sources such as fruit. Fast forward to the present day and the average fructose intake is approaching 60g per day, with adolescents consuming over 72g per day. Alarmingly, fructose is contributing over 10% of daily calories! As you can imagine fruit is not contributing much to this excessive intake. The vast majority of fructose consumed is due to added sugars present in ready meals, snacks and sweetened beverages that are high in energy but provide minimal essential nutrients. This is the problem, not fruit. To provide some perspective, a 500ml bottle of Coke original contains 53g of sugar. As half of sugar is fructose, there is 26.5g of fructose per bottle. When you think of this in the context of a traditional western diet which comprises of many processed goods it is not difficult to see how the average person is consuming 60g per day. To provide a comparison to the bottle of cola, you would have to consume roughly 3 large apples, 5 small bananas, 500g of cherries or a kilo of strawberries to obtain the same amount of fructose. Again, fruit is not the problem and is certainly part of a healthy diet. That being said, the type and form of fruit does have a bearing on the impact it has on the body. Dried fruit and fruit juice provides significantly more fructose and less fibre than whole fruit by comparison. This is one reason why the Department of Health recommend no more than 150ml of fresh fruit juice per day. So, if you are worried about your fructose intake, it goes without saying that added sugars should be heavily controlled. You may also want to avoid dried fruit and fruit juice, and just focus on consuming whole fruit. Summary Hopefully this article has raised awareness about the potentially harmful effect of excessive fructose intake and has encouraged you to consider the amount that you consume each day. Like most topics in nutrition, a focus on mainly eating whole, unprocessed foods and limiting the items which are detrimental to our waistlines and metabolic health is the safest route forward. Sources: https://academic.oup.com/jcem/article/89/6/2963/2870348https://academic.oup.com/ajcn/article/88/5/1189/4649075https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714385/https://www.healthline.com/nutrition/why-is-fructose-bad-for-you#section3https://www.healthline.com/nutrition/why-high-fructose-corn-syrup-is-bad#section2https://www.ncbi.nlm.nih.gov/pubmed/22952180https://www.ncbi.nlm.nih.gov/pubmed/26707365/https://www.sciencedirect.com/science/article/pii/S0168827808001645https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5663253/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4405411/https://www.diabetes.ca/diabetes-and-you/healthy-living-resources/weight-management/waist-circumferencehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2234536/https://www.ncbi.nlm.nih.gov/pubmed/18769702
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Top Reasons to Eat Breakfast Every Day
We have all heard statements such as ‘breakfast is the most important meal of the day' and that ‘eating breakfast boosts the metabolism'. Technically, we all eat breakfast during our first meal of the day, as this breaks the fast. However, for the purpose of this article, we are going to describe breakfast as a meal eaten in the morning. In this article we are going to outline the top reasons why you should eat breakfast every day and also why breakfast may not always be necessary for some people. Furthermore, we will discuss some of the common sentiments of breakfast and explore whether these are fact or fiction. Why Should You Eat Breakfast? Energy Levels Although food is one of life's pleasures for many people, we primarily eat for two reasons: to obtain both the energy, and the nutrients, that are essential for a healthy body. By having a healthy and balanced breakfast (more on this later), we will be setting ourselves up for a productive morning. We should have enough energy to carry-out our daily tasks and we will be nourishing our body with nutrients that keep our health in check. Unless we have woken up and eaten during the night, it is likely that we will have gone for around 12 hours without eating, meaning that blood sugar and energy levels will be low. For this reason, having breakfast is a good idea, especially for those of us who either have a physical job, or an occupation that requires high levels of concentration. It is well documented that physically intense jobs are mostly fuelled by glucose. Similarly, our brains rely almost exclusively on glucose, so for most people we are likely to be more efficient in our jobs if we have had breakfast. Satisfy Hunger Another important reason to eat a healthy breakfast is to satisfy our appetites. Not only is hunger likely to cause physical symptoms such as a lack of energy, but it can also negatively affect our mood and behaviour. When hungry, we also tend to be drawn towards highly palatable foods – foods that are often high in calories, salt, sugar and fat but devoid of essential nutrients. For some people, therefore, having a satisfying breakfast reduces the likelihood of snacking on unhealthy foods during the morning. Body Composition Breakfast is an important meal for people aiming to optimise their body composition, such as athletes and older adults. Athletes need to maximise their physique for performance, while older adults need muscle and strength to stay functional and independent. Ensuring that an energy and protein-rich breakfast is consumed is of high importance to both of these population groups. Eating breakfast contributes to the daily recommended protein intake. It also helps to provide protein at regular times through the day, which is optimal for muscle health. Conversely, skipping breakfast could mean that a quality protein source is not consumed for upwards of 16 hours, which will make it difficult to achieve the daily recommended amount. For those of us who value our muscle health, a quality breakfast is certainly a good idea. Health Benefits Aside from the energy and productivity standpoint, eating breakfast is also associated with health benefits. Over 60 years ago, nutritionist Adelle Davis coined the phrase ‘eat breakfast like a king, lunch like a prince and dinner like a pauper'. Although at the time there was no concrete evidence to back this statement up, recent research has shown that her advice could be worth following. Like many areas of nutritional research at the moment, the study we are going to look at aimed to improve the condition of type 2 diabetes - a disease that is known to affect a twelfth of the world's adult population. As the health complications of diabetes are due to abnormally high blood sugar levels, scientists are looking at lifestyle measures to take control of this. This landmark study assessed whether a large breakfast and a small dinner was more effective than a small breakfast and large dinner for managing diabetes. Both diets had the same sized lunch and all participants ate the same foods and the same amount of calories regardless of what meal plan they followed. What fascinated the researchers was that despite the identical macronutrient and energy intake, changing the size of meals in favour of a large breakfast and a small dinner was substantially better with regards to diabetes management. Specifically, it was found that this pattern of eating led to 20-25% lower blood sugar levels at lunch time when compared to the other group. This allowed the participants to achieve the blood sugar target that has been shown to decrease the risk of cardiovascular problems in type 2 diabetics. This certainly has clinical relevance. These impressive results are down to what scientists call our “circadian rhythm”, or the body's natural clock. Numerous research studies have shown that we deal with carbohydrates better in the morning because of the more efficient workings of our hormones. This results in us being more sensitive to the action of insulin, meaning more glucose can leave the blood and enter our cells where it can provide energy. It seems that if you are a diabetic, or are at risk of developing the disease, breakfast really is the most important meal of the day. Why You Could Skip Breakfast One point that nutritionists like to stress is that our diets are very personal and are individual to us. Consequently what works well for one person may not be effective or healthy for someone else. Now we have made a compelling argument for why we should focus on eating a healthy breakfast daily, it's important to assess under what conditions it could be perfectly fine to skip breakfast. Hunger To reiterate the message that all of us are different, some individuals wake up ravenously hungry, whereas others struggle to eat at all. Many people find they can function perfectly well in the morning on fluids such as tea or coffee and not eat anything of significance until mid-day. If you do not have the desire to eat, it makes little sense to force a meal down unless you have a good reason to, such as a physical job or an intensive exercise session. Given the well-documented problems that stem from over-eating, those who don't feel the need to eat breakfast should not feel forced to do so. Health Benefits As we have found earlier, eating breakfast does have proven health benefits at least from a metabolic health perspective. However, there are also health benefits of fasting for extended periods of time, which breakfast skippers will naturally achieve. From animal research, it is known that ‘time-restricted eating' can not only increase longevity, but also decreases the prevalence and progression of a variety of chronic illnesses. Although the research is currently sparse in humans, there is evidence to suggest that prolonging the duration of a fast can decrease inflammation in the body. As inflammation is thought to play a role in most chronic diseases, these findings hold significance, however quite how much significance is not currently known. There is also research to show that intermittent fasting (the most popular method of time-restricted eating) can exert a positive effect on the gut microbiome. Among other important actions, a healthy gut microbiome helps to support immunity and regulate inflammation. This area is primed for further investigation. On the other hand, there is convincing evidence that people who work night-shifts, and therefore eat later at night, disrupt their natural body clock. This has been shown to have adverse metabolic health effects, increasing the risk of illnesses such as diabetes. Some experts therefore believe that people wanting to experience the benefits of an extended fast should have a small evening meal or skip it all together, as opposed to skipping breakfast. Weight Loss Benefits Skipping breakfast and weight loss is a contentious topic. Some believe that breakfast is important for ‘boosting the metabolism', and that not having breakfast leads to a compensatory effect by overeating later in the day. On the contrary, others state that missing breakfast is an easy way to decrease calorie intake and lose more weight than a breakfast eater. Let's break this down. Firstly, all meals boost metabolism, as the body uses energy to break down the carbohydrates, fats and proteins from food. This is called the thermic effect of food. If two days of eating are identical from an energy and macronutrient perspective, the thermic effect of food and subsequently the increase in metabolism will be the same, regardless of whether breakfast is consumed. There is a plethora of scientific studies that have shown that an intermittent fasting style diet (by skipping breakfast) is an effective way to lose weight. However, there is zero evidence to show that this is a superior way of losing weight compared to a diet that includes breakfast. Like many areas in nutrition, this conundrum is really down to individual preference. If you wish to miss breakfast for weight-management purposes, it is important to understand that this is not a magic solution, and is instead merely another strategy to reduce overall calorie intake. Sleep In the UK, statistics show that over a third of adults only get 5-6 hours of sleep per night. Although there are numerous factors which are influential in sleep, diet is a key element. For example, it is known that carbohydrates can act like a sedative, as the body does not like to drift off without knowing it has sufficient blood glucose. Similarly, a protein-rich evening meal has been shown to positively influence brain chemicals that regulate the sleep-cycle. If you are struggling to get a good night's sleep, it may be worth eating most of your daily carbohydrates and protein in your evening meal and having less earlier in the day, which can be done by omitting breakfast. Good Foods to Eat at Breakfast It is clear that eating breakfast is a very individual choice, and that there are arguments for both sides. At the current time however, there is more research to indicate the benefits of eating breakfast than not. If you are someone who likes eating breakfast and requires it to function properly, this section is for you, as we will help you build a breakfast that will set you up for the day. Like various other aspects of nutrition, we could be doing a lot better when it comes to what we eat for breakfast. Unfortunately, on most breakfast tables there will be an omnipresence of cereals that are high in sugar, and low in both protein and fibre. Some of these cereals are so nutritionally deficient that they have been fortified with vitamins and minerals to make up for this. Similarly, white bread in the form of toast is another staple which fairs no better. Research seems to be emerging monthly to further reinforce that our diets should be based mostly on fruits, vegetables, wholegrains, legumes, nuts, poultry, oily fish and olive oil. On the other hand, we should aim to limit (or totally omit) refined carbohydrates and fried, fatty, sugary and processed foods. To build a breakfast around these recommendations, one option that is both popular and healthy is porridge oats, with a portion of fruit such as a banana or berries. When made with milk, this will provide an appreciable amount of protein and carbohydrates to provide sustained energy. This breakfast is also high in fibre, vitamins and minerals to support general health. Another example of a healthy breakfast that would provide a nutritious start to the day is something egg-based. Two eggs with spinach, tomatoes and mushrooms and a slice of wholegrain toast will provide similar benefits to porridge. Although neither of the above breakfast ideas will take too long to rustle together, people living busy lives may wish for something even quicker. A fast and nutrient-dense breakfast can be as simple as a fruit smoothie, which will provide natural carbohydrates, fibre, vitamins, minerals and antioxidants. To further improve the breakfast without taking up any more time, a handful of nuts could also be consumed. Summary Hopefully this article has made it clear that breakfast, and meal timing in general, is a complex topic that can often throw up contradictory findings. Nutrition is a very difficult topic to research because there are so many variables, which is further compounded by individual differences in humans. From our current understanding, there seems to be more benefits to eating breakfast than not, but this doesn't necessarily mean that missing breakfast is unhealthy, as long as nutritional demands are met at other times of the day. On a final note, listening to your body and having an eating plan that is tailored to your individual needs is something to be encouraged. As long as your overall diet is nutritious, the timing of your meals is of much less importance. Sources: https://www.sciencedaily.com/releases/2015/02/150224182541.htmhttps://link.springer.com/article/10.1007%2Fs00125-015-3524-9https://www.endocrinologyadvisor.com/endo-2018/reducing-total-daily-insulin-dose-in-t2d-with-3-meal-diet/article/750900/https://www.ncbi.nlm.nih.gov/pubmed/29571007https://www.ncbi.nlm.nih.gov/pubmed/27737674https://www.annualreviews.org/doi/full/10.1146/annurev-nutr-071816-064634?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&http://www.mysportscience.com/single-post/2017/09/10/Nutrition-to-improve-sleep
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