I was recently interviewed and featured in IHCAN (Integrative Healthcare and Nutrition) magazine. It’s the UK’s only monthly magazine for practitioners of integrative medicine and, as you can imagine, is highly regarded in the integrative health industry.
You can read the article in full, where I talk about my work and the services I offer, below.
Subscriptions to the magazine are available on their website, at https://www.ihcan-mag.com/
We all know that sugar is the root of all evil right? Too much of the white stuff has been linked to a range of health issues such as obesity, heart disease, diabetes and mental health, to name a few. Tax on sugary drinks is a hot topic, with the UK poised to add 6-8p on a can of fizzy pop in April next year and Ireland recently announcing to add 27p per litre. But the ‘can the tax’ campaigners in America have recently dumped the 1 cent per ounce levy on fizzy drinks in Chicago. (1) Lobbyists from the drinks industry are piling on the pressure to scrap the tax, and campaigners from the health industry to increase it. It’s uncertain which way it will go in the UK at the next budget. What is clear, is that the debate has highlighted the dangers of high sugar products such as fizzy drinks and confectionary. We all know that we shouldn’t be filling ourselves or our kids up with this stuff.
Because of the backlash against sugar, many manufacturers are seeking alternatives to sweeten food. Products and recipes use artificial sweeteners, natural sugar substitutes, fruit syrups, dried fruits and other agents in an attempt to claim ‘low sugar’. More recently the buzzword is ‘refined sugar’ and we are told that we should avoid this at all costs. So, if a products states on the packet that it has no or low refined sugar, but it still contains 20g sugar per 100g on the ingredients list, is this OK? Confused? Greater clarity is needed beyond the obvious ‘poor choices’ that we all know to avoid. To make an informed choice you need to know the facts and hopefully I can help.
WHAT IS SUGAR?
First you need to understand the basics. This is the science bit, but I’ll keep it short. Sugar is a carbohydrate that is present naturally in fruit and vegetables and in dairy products as lactose. The two main types are simple carbohydrates (monosaccharides and disaccharides), and complex carbohydrates (polysaccharides). Mono means one and saccharides means sugar, so essentially, these are single sugar molecules: glucose, fructose and galactose. Di means two, so these are two of the single sugar molecules joined together, making maltose, sucrose or lactose. Poly means many, so as you would expect these are a string of sugar molecules (starch, glycogen and cellulose). Following so far? The picture below should help. (2)
HOW DOES THE BODY USE IT?
In order to understand this further, you need to know how the body uses it. All foods falling into the carbohydrate category, either natural (e.g. potatoes) or processed (e.g. bread) are broken down in the body to a single sugar. So, bread, pasta, rice, vegetables, chocolate, pastries and biscuits ALL turn into glucose eventually, which is the primary fuel for the brain. The rest is used immediately for energy or stored in muscle cells or the liver for later use. When circulating in the blood, glucose is known as ‘blood sugar’ and insulin is secreted from the pancreas when levels rise, to take glucose into our cells. This prevents blood sugar from getting too high, which is dangerous for health.
The speed which your body absorbs sugar is partly determined by the amount of fibre in food, which slows the process down. That’s why it’s better to eat whole, unprocessed foods. Eating the whole fruit, rather than just the juice is a good example and I am a big fan of blending smoothies rather than juicing, for this reason. The other foods on your plate will also have an impact on blood sugar in your body. If you have a balance of proteins and good fats on your plate, this will further slow the absorption of sugar. So, it is definitely better to include something from each food group with all your meals and snacks.
WHAT ABOUT FRUCTOSE?
Fructose is a sugar found naturally in many fruits, some vegetables and honey. However, it is unlike other sugars because it is not the preferred energy source for muscles or the brain and it’s only processed in the liver. It also has minimal impact on blood sugar levels and does not cause insulin to be released. In the past, this has led to the thinking that we can eat as much fruit as we like, because it doesn’t cause blood sugar spikes, or pose health issues.
Evidence is now emerging which raises concerns about high intakes of dietary fructose, because it can be converted to fat in the liver. Much of this research stems from the prevalence of high fructose corn syrup (HFCS) in the food industry. In America, the per capita consumption of HFCS in 2016 was 41.4 pounds. (3) The consumption in the UK is currently lower, as both sugar and HFCS have been subject to export quotas and production restrictions. Worryingly these limits were lifted by the EU on 1st October this year. (4) This gives food manufacturers free reign to switch to fructose corn syrup, should they choose.
Childhood obesity expert, Dr Robert Lustig explains that as there isn’t a hormone to remove fructose from the blood, it’s stored in the liver as glucose, or turned into a fatty acid molecule called a triglyceride. These fats are returned to the blood and deposited around the body. Once the fat stores are full, they can travel to the heart or liver posing serious health risks. (5)
Recent evidence also links fructose to gut health, revealing that it can cause damage to the intestinal lining and imbalance our gut bacteria. (6) Excessive amounts could therefore contribute to a range of health disorders and can also cause bloating and digestive discomfort. We mustn’t forget that there are a host of fibre, vitamins, minerals and antioxidants in fruit, so it shouldn’t be demonised. However, intake should not be unlimited, more on that later.
REFINED VS UNREFINED
We all know that it’s better to eat whole fruit (in moderation) and vegetables, rather than a chocolate bar. We’ve learned that natural carbohydrate sources will give more sustained energy and stable blood sugar. But what exactly is a refined sugar?
Refined sugar comes from sugar cane or sugar beets, which are processed to extract the sugar. It is typically found as sucrose (commonly known as table sugar), which is the combination of glucose and fructose. During the refining process, all the vitamins, minerals, fibre and antioxidants are stripped away.
Food manufacturers add refined or chemically produced sugar (HFCS) to many foods and drinks to make them more palatable. A lot of these are not things you might typically expect to find sugar in and low-fat foods are often the worst offenders. Get in the habit of checking labels to see what the sugar content is, you might be surprised as you can see! (7)
Unrefined sugar on the other hand, retains all the natural nutrients. These are raw, unrefined sugar products such as honey, maple syrup, brown rice syrup, date syrup and molasses. But, here is where you must be careful, because these unrefined ‘healthy’ sugars can also have refined versions.
The processed golden honey found in supermarkets is completely different from ‘raw’ unpasteurized honey which still contains beneficial enzymes, vitamins, minerals and antioxidants. It also has a GI of about 75, compared to raw honey at around 30. Processed maple syrup that is commonly used on pancakes is often flavoured with maple and loaded with sugar or high fructose corn syrup. Choosing a ‘pure’ maple syrup ensures that it is not as refined and still contains beneficial nutrients. You will pay a premium for these products; however, you need to use a fraction of the amount of the cheaper more processed versions. Supermarkets won’t always stock these, so head to your health food store, or shop online.
WHAT ABOUT DRIED FRUIT?
Lots of recipes are now suggesting that we substitute refined sugar for dried fruits such as raisins, prunes, apricots and dates. Dried fruit has had all the water content removed and with this, the vitamin C content is also dramatically reduced. The fibre and antioxidant content, however are increased. (8,9) But if we look at the fructose content of a range of fruits, it is dried varieties that top the chart. (10)
So, as with everything in life, it is all about balance. If you are going to ditch refined sugar and start eating 20 medjool dates every day, this is probably not the best idea! However, if like me you are going to use dates in recipes to replace sugary snacks and use these sparing, then it’s better than using the refined sugar. Healthy snacks such as energy balls usually use dates (incidentally I use deglet noir as they are not only cheaper but lower in fructose) and I would have one ball a day as a ‘sweet treat’. I find this chart really useful to moderate the amount of high fructose fruit that is consumed. It does shed light on the downside of giving kids boxes of raisins daily, versus say a tangerine.
HOW MUCH DO WE NEED?
The NHS states that we shouldn’t have more than 5% of our calorie intake as sugar, which is 30g of sugar (7.5 teaspoons) a day for anyone aged 11 or over. Children aged 7-10 should not have more than 24g a day (6 teaspoons) and aged 4-6, no more than 19g a day (just under 5 teaspoons). (11) So, you start the kids’ day with a bowl of cheerios and a glass of orange juice, pack them off to school with a carton of fruit juice in their packed lunch and then a kids yogurt later. This, without any ‘sweet’ treats gives them about 12 teaspoons of sugar!
The Government supports the UK Eatwell Guide which shows you their version of a healthy plate and what should come from each food group. (12) On this, they do not include sugary foods at all, but show them separately, saying ‘eat less often and in small amounts’. Their advice is still to eat 5 portions of fruit and vegetables daily, which I believe is now outdated. We should not be eating to prevent disease, rather we should eat to optimise health. From this perspective I much prefer the Alliance for Natural Health ‘Food4Health Plate’ which state that we should eat from 6 groups each day; vegetables (40%), Fruits (10%), Grains (10%), Healthy Fats (10%), Protein (25%) and concentrated nutrients (5%). (13) This could be developed further to include fermented foods, which are beneficial for gut health and are thankfully becoming more readily accessible.
In my opinion we should strive to include 6-8 vegetables a day and minimise fruit to 2-3 portions. Using the fructose guide, it would be smart to try and ensure that you aren’t picking all the high fructose varieties. Dried fruits should be minimised and used sparingly as treats. People with blood sugar and digestive issues could benefit from minimising further, or even removing fruits completely. There should always be room for a treat, so try to pick a day or evening that is your treat time and think about minimising the quantity of the treat, so it’s not a binge! When choosing packaged products, try to pick the lowest percentage of sugar per 100g that you can (under 5% would be a good start) and eat whole foods as much as possible. Remember that if you enjoy a drink on the weekend you should also consider the sugar content. A large glass of dry white, prosecco or red wine is a quarter of a teaspoon, a pint of ale 1 tsp, a pint of lager is 2 tsp, and a pint of sweet cider such is up to 5 tsp! If chocolate is your weakness, treat yourself to a bar of raw chocolate which is made by roasting the cocoa beans to much lower temperatures. This retains nutrients and antioxidants that are usually destroyed. It’s also dairy and refined sugar free.
SUGAR ALTERNATIVES
So, what about the myriad of sugar alternatives on offer? Well here’s an overview and my advice on the ones to buy and avoid:
For the best choice of all these products, you should head to a health food store, as you won’t find them all in the supermarket.
THE 28 DAY CHALLENGE
So, it all sounds a bit gloomy, right? Basically, there is sugar everywhere. But honestly, it’s not as hard as you think to cut down. By making a positive change you are not only taking control of your health, but you will most likely shed a few pounds at the same time. As an experiment, I cut all refined sugar and alcohol from my diet for 28 days about a year ago and did not find it nearly as hard as I imagined. Although during this time I did include fruit (2 a day) and used dried fruit (dates) to provide me with healthy ‘treats’ (again 1 small treat per day). I used sugar alternatives sparingly for baking and increased my protein and vegetable intake. I found myself way less hungry, my energy levels improved, my hormones balanced and I lost 1.5 inches from my waistline. I found that the alternatives I used were more than enough to satisfy any cravings (which by the way also reduced dramatically). I now have very little sugar in my diet at all and really don’t miss it.
Try the 28-day challenge, it might just step change your diet (and health) for good!
REFERENCES
We only became interested in the role of dietary fibre in humans towards the end of the nineteenth century. Building on the work of other scientists, a surgeon called Denis Burkitt proposed what is now known as ‘The Dietary Fibre Hypothesis’ in 1972. (1) At the time, this somewhat radical view identified that diets low in fibre increased the risk of many degenerative disorders such as cardiovascular disease, obesity, diabetes, cancer and bowel conditions, to name a few. So, public interest in fibre was put firmly on the map and the food industry went on an all-out fibre assault. Cereals were an obvious win for food manufacturers and subsequently ‘high fibre’ claims were established.
Fast forward to now and it’s not in dispute that fibre is beneficial, in fact research into fibre and digestive health particularly has evolved considerably (more on that later). There is a big market for products rich in fibre and a trend to find new sources. But what exactly is ‘high fibre’, where should we get it from and what does it do for us? I’ve written the fibre file to hopefully arm you with the facts, so that you can make an informed decision on your food choices.
WHAT IS FIBRE?
Its definition has been subject to a great deal of debate over the years. The most recent definition seems to be globally agreed as: ‘dietary fibre is made up of carbohydrate polymers with three or more monomeric units (MU), which are neither digested nor absorbed in the human intestine’. (2)
In simple terms, fibre is the indigestible portion of food derived from plants. It is often described as soluble fibre (e.g. in oats and fruit) and insoluble fibre (e.g. in wholegrains and nuts), simply meaning that can or can’t be dissolved in water. Insoluble fiber is found in the cell walls of plants and is beneficial as it adds bulk to stools to assist in moving them out of the digestive tract. Soluble fiber on the other hand dissolves in water and helps to slow the passage of food through the digestive tract, lower blood sugar levels, and reduce cholesterol.
For the science brains amongst you, dietary fibre is technically a non-digestible polysaccharide. If you read my previous article on sugar ‘The Sweet Truth’, you may remember the diagram below. (3) Within the polysaccharide category, there are some types that are not digested or absorbed in the stomach or small intestine and therefore can’t be broken down into single sugar molecules. Cellulose is just one example, however there are now around 16 different types, as identified by a 2017 review of dietary fibre in Europe. (2) It’s way too confusing to talk about them all, however the following table gives a good summary of some of the main types along with their sources and health benefits. (4) Note that the fibre used to give TROO granola its sweet taste is inulin, derived from the chicory root and has benefits for both gut and immune function.
SO, WHY DO WE NEED IT?
We know that fibre is not digested or absorbed in the stomach and small intestine, so how is it useful? It’s probably best known for its role to alleviate constipation; however, we now know that it has many more important functions. These range from the reduction of glucose and cholesterol absorption in the small intestine, providing bulk for our stools (which minimises toxicity and aids hormone balance), influencing metabolic activity in the gut and the production of energy resources for the body. As a result, clinical studies suggest fibre exerts a wide range of benefits in areas such as bowel function, immunity, blood glucose control, cholesterol levels and gut health and hormone balance. (5)
We know that dietary fibre decreases the risk of bowel cancer, likely because of the effect it has in bulking our stools and moving waste through the colon quickly. As our stools contain carcinogens and toxins, we really don’t want them hanging around in there for too long! Did you know that up to 80% of our immune system is in the gut? This is because the digestive tract is lined with active immune tissue. The immune enhancing effect of dietary fibre and the link between the gut and our immune systems is an exciting and growing area of research.
In terms of regulating blood sugar levels, foods which contain fibre take longer to digest and therefore slow the absorption of glucose, in particular the soluble mucilage and beta glucan varieties from the previous table found in oats, nuts, seeds and beans. The body does not produce insulin in response to fibre, so inclusion of adequate levels can lead to lower blood glucose and decrease subsequent risk of diabetes and cardiovascular disease. Soluble fibre has also been shown to lower LDL blood cholesterol (the bad type) in a number of different ways. An all-round win for heart health.
And as if those reasons weren’t enough, eating fibre can also help with weight loss. Blood sugar balance is key this, however fibre also fills you up as it absorbs liquid in your stomach and this fullness stimulates receptors to tell your brain to stop eating. Fibre helps to eliminate excess hormones in our stools which can also aid weight loss.
FIBRE AND GUT HEALTH
The emerging research in this area is fascinating. A recent research paper identified 188 relevant studies in the area of the human gut ‘microbiota’ (or gut bacteria) and the consumption of dietary fibre. (6) It seems that the amount and type of fibre consumed can have a huge effect on the number of beneficial bacteria in our gut. We used to think that fibre did not provide any energy to the body, however it is now known that some types can be fermented in the large intestine by our gut bacteria. This process feeds the good bacteria and helps them to grow.
It also produces short chain fatty acids (SCFAs) which can be absorbed into the blood stream and used as energy, as well as providing food for the cells of the colon. In the last few decades, it became apparent that SCFAs may play a key role in the prevention and treatment of metabolic syndrome, bowel disorders, and certain types of cancer. (7) When bacteria in the lower intestine break down fiber, a substance called butyrate is produced which may inhibit the growth of tumors of the colon and rectum (8)
This fermentation, leading to beneficial changes in gut bacteria comes from fibre termed as ‘prebiotic’. Prebiotics are defined as “a selectively fermented ingredient that allows specific changes, both in the composition and/or activity of the gastrointestinal microbiota that confers benefits.” (9) Prebiotics fall into the oligosaccharide and inulin category and sources include raw leeks, onions (cooked or raw), green bananas, chicory root, raw asparagus, raw garlic, jerusalem artichoke and dandelion greens. (10)
Before you all start loading up on the foods above, there should be a word of caution for anyone suffering from digestive issues such as IBS. There has been research to suggest that these fermentable fibre sources can aggravate the symptoms of IBS such as bloating, discomfort and flatulence. (11) It is not the fibre itself that is causing the issue, but rather the fermentation process, as sufferers from IBS usually have abnormal bacterial balance and therefore undesirable, or ‘bad’ bacteria may be feeding from the fibre. (12)
A specific dietary approach has been identified in helping symptoms of those with IBS, called FODMAP, which stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (bit of a mouthful hence the need for an acronym!) It relates to the dietary restriction of poorly digestible carbohydrates that are easily fermented in the gut and includes some of the fibre sources we have been discussing. Although this approach can be successful in relieving symptoms, it is important to note that it may not be addressing the underlying causes of IBS. The hypersensitivity of the gut in IBS sufferers is something that should firstly be assessed by a trained nutritional professional, as this dietary regime is restrictive and excludes many beneficial foods. (13)
HOW MUCH IS ENOUGH?
So, hopefully you now have a better understanding of fibre, how much do we need to eat? In 2015 the Government announced new guidelines, following the SACN Report on Carbohydrates and Health stating that intake should be as follows: (14)
| Age (years) | Recommended intake of fibre |
| 2-5 | 15g per day |
| 5-11 | 20g per day |
| 11-16 | 25g per day |
| 17 and over | 30g per day |
The new level represents an increase of 7g per day for adults and the report suggests that to meet this, it would be necessary to consume around 3-5 servings of fibrous vegetables (for example peas, broccoli and carrots), 2-4 servings of fruit (for example an apple with skin, a portion of strawberries and an orange) plus 3 servings of wholegrain bread/pasta/beans/pulses (for example, 2 slices of wholemeal bread, lentils and wholemeal spaghetti). (14) The link between higher consumption of dietary fibre and a reduced incidence of the health issues already discussed was the driver for this change.
It is estimated that the current adult intake in the UK is 12g below the new recommendation, at only 18g of fibre daily. The sources are estimated to come from cereals (39%), vegetables and potatoes (31%), fruit (9%) and meat products (11%). (15) I have to say that I found it shocking that meat products, which contain little, to no fibre showed a higher consumption percentage than fruit! One can only assume that this figure is driven by processed meats which have fibre added for both technological reasons and for benefits to health. (16)
For a manufacturer to claim that a food is high in fibre, the product must contain at least 6g of fibre per 100g or at least 3g of fibre per 100 kcal. (17) But is 6g per 100g really a ‘high’ level? I would urge you to check out any packaged goods you buy to make the comparisons. Did you know that two of the leading ‘healthy’ granola brands on the market contain only 6.9g and 10.6g of fibre per 100g, compared to TROO granola at a massive 16.7g-18.3g, depending on which variety you choose.
WHAT SHOULD I EAT?
There’s a sensible approach to fibre intake in my opinion, in fact, it’s an approach to healthy eating more than anything. Think about food sources being the least processed and as close to the ‘whole’ food as possible. The advice to consume 8-10 portions of fruit and veg (with only 2-3 as fruit) is a good one. I prefer blending to juicing, as the fibre is retained and soup with added vegetables and grains is another way to boost fibre levels. Vegetables as crudités make a quick high fibre snack option too.
In terms of grains, stick with wholemeal varieties and steer clear of white refined foods. Be experimental with the wide range of fibre rich grains on the market that are also high in protein, vitamins and minerals, such as quinoa, buckwheat, millet and amaranth. Include some of the fermentable fibre sources that are known to be beneficial for gut health (assuming that you do not have any digestive issues). Eat your bananas green, or chop and freeze them green to add to smoothies.
Be mindful of being seduced by ‘high’ fibre claims when there are alternatives with higher levels. If these foods are also high in sugar, then it’s a no-no. Cereal brands and snack bars are the worst offenders here. For example, a popular brand of cereal bar that I looked at, had high fibre (at 7.7g) but included a whopping 32.5g of sugar per 100g! There are countless cereals on the market that have incredibly high levels of sugar, so always check the pack before you buy. Oats and oat bran are heart healthy fibre rich options if you like to alternate your TROO granola with porridge or overnight oats.
Do include legumes – that’s beans and pulses, which are high in fibre and don’t forget that nuts and seeds make a great snack with added fibre too. Flax or linseed which you can buy milled as a powder is really versatile for adding to baking and cereals and has 27g of fibre per 100g. Chia seeds have become popular and can be included in lots of different recipes too and have 34g of fibre per 100g.
Eat as wide a range of food from as many different good sources as you can. And remember that not all fibre is created equal, so a couple of slices of toast each day isn’t going to suffice!
References
