145: How to Sugarproof your kids with Dr. Michael Goran
Sugar has a bad name these days – much like fat did back in the 1990s. “Research shows” that it’s addictive…that it shrinks your brain…that it’s likely to lead to all kinds of health problems.
But will it really?
I interviewed Dr. Michael Goran, author of the recent book Sugarproof: The Hidden Dangers of Sugar that are Putting Your Child’s Health at Risk and What You Can Do. This is a pretty alarming title, and I was interested to dig into the research behind the book as a continuation of our exploration of topics related to parenting and food. It turns out that yes, there’s a lot of research on this topic. And a lot of it supports the idea that sugar may be harmful to children…but the case wasn’t nearly as clear-cut as I’d imagined it would be.
In this episode we discuss the research on which the book is based, and what practical steps parents can take to reduce their child’s sugar intake if they decide they want to do that.
Dr. Michael Goran’s Book:
Sugarproof: Protect Your Family from the Hidden Dangers of Excess Sugar with Simple Everyday Fixes (Affiliate link).
Click here to read the full transcript
Jen Lumanlan 00:02
Hi, I’m Jen and I host the Your Parenting Mojo podcast. We all want our children to lead fulfilling lives. But it can be so hard to keep up with the latest scientific research on child development and figure out whether and how to incorporate it into our own approach to parenting. Here at Your Parenting Mojo, I do the work for you by critically examining strategies and tools related to parenting and child development that are grounded in scientific research and principles of respectful parenting. If you’d like to be notified when new episodes are released and get a free guide called 13 reasons why your child won’t listen to you and what to do about each one, just head over to yourparentingmojo.com/subscribe. You can also continue the conversation about the show with other listeners in the Your Parenting Mojo Facebook group. I do hope you’ll join us.
Jen Lumanlan 01:00
Hello, and welcome to the Your Parenting Mojo Podcast. Today we’re continuing our series of episodes at the intersection of parenting and food with a topic that I know many parents have been eagerly awaiting. We’re going to do a deep dive into the research on how sugar impacts our children. And so my guest today Dr. Michael Gordon is a Professor of Pediatrics at the Children’s Hospital of Los Angeles, which is affiliated with the Keck School of Medicine at the University of Southern California. He’s program Director for diabetes and obesity at the southern Research Institute and he holds the Dr. Robert C and Veronica Atkins endowed chair on childhood obesity and diabetes. Dr. Goran also serves as co-director of the USC diabetes and obesity research institute and he published over 350 peer reviewed articles and reviews. And as editor of the book Childhood Obesity; causes, consequences and intervention approaches. Co-editor of Dietary Sugars and Health and his most recent book co-authored with Emily Ventura is Sugar Proof; the hidden dangers of sugar that are putting your child’s health at risk and what you can do. Dr. Gordon has received a variety of awards from his work. He’s a native of Glasgow, Scotland, and received his Ph.D. from the University of Manchester in England. Welcome Dr. Goran.
Dr. Goran 02:08
Hi, Jen, nice to be here. Thank you so much for having me on and for bringing up this important topic.
Jen Lumanlan 02:15
Thank you. And so I wonder if we can start with just a brief overview of your recent book sugar proof and what that contains because we’re going to spend most of our time digging into the research that you cite in that book.
Dr. Goran 02:26
Yeah, so sugar proof, which was published last year, basically, I wanted to write a book that summarized the research, because the research doesn’t always reach the public. So we wanted to get the research out there because families everywhere need to know how and why sugar is affecting kids, short-term, long term, and what we can do about it. So the first section of the book is the science of how sugars affect kids, and why kids are more vulnerable. The second is how to change that in your family, with simple tips, recipes, meal plans, challenges, and so on. And then the third part is the sugar-proof kitchen with recipes and getting kids involved in the process. So we want to put all that together and package it because we think it’s just such an important issue right now.
Jen Lumanlan 03:22
Yeah, okay, great. And so we’re going to spend most of our time today focused on the first portion of the book, which is about what the research says about sugar. And yeah, I know that the second and third portions are just as important. And I’ve actually been working with my family and some listeners as well on ways that we can incorporate the ideas from the book and shift our own consumption of sugar and see where we hadn’t necessarily been seen before. So but today, we’ll focus on the scientific research. And so let’s start with children’s preference for sugary foodsm and I know that you describe your daughter’s elementary school science experiment where we she showed an innate preference for sugar where children had a stronger preference for lemonade that had more sugar stirred into it. And teenagers and adults had a lower preference for lemonade with a lot of sugar stirred into it, and they preferred the less sweetened versions. And I’m curious about whether this preference for sugar is learned or innate. Can you speak to that to start, please?
Dr. Goran 04:20
Yeah, I think it’s both. I think there is an innate preference and a learned adaptation. So we know not just from my daughter’s little experiment, but research studies have shown that there’s a built-in preference that we’re born with a preference for sweetness. And the thought there is that it’s supposed to be protective from an evolutionary perspective. It’s supposed to favor liking of breast milk, which is sweet, to favor the seeking out of good calories, and to avoid food spoiled or become contaminated, and to avoid toxic foods. But now the food environment is very different than what it was for those ancestors where 80% of foods targeted towards children have added sugars, which has over 200 different names. So I think the food environment in which we’re now living is very different to our ancestors. And as soon as infants and children get exposed to sugar, that built-in preference gets amped up even higher. And that’s becoming problematic because that just translates to craving more sugar, more sweet foods. So that’s the problem that we’re faced with.
Jen Lumanlan 05:31
Okay. And I know that a lot of the studies that you cite in the book are from experiments on rats, and one of the ones that I want to quote from is, in the book, you say, “If a pregnant mother consumes excessive sugar or sweetness in any form, it can reach the unborn baby, who will then develop an even greater than usual preference for more sweetness.” And so I took a look at the paper that you cited there. And that paper actually didn’t specifically look at Sugar, but actually call it and looked at what the author’s called a junk food diet, which is a pretty loaded term and included foods like cookies and jam doughnuts, but also potato chips. And the rats were in these cages, and you’re getting a choice of either this nutritionally balanced and probably pretty boring rat chow, or these jam, doughnuts and potato chips. And I was sort of just thinking, you know if I’m a rat in a cage, am I going to choose this boring food? Or am I going to choose this probably calorically dense and tasty food? And I’m wondering if that is a rat is the most exciting part of my day, can I really compare the rats response here to living in a cage, but there’s nothing else to do to a life where we’re out in the world, and we’re doing other things, and this is a small part of how we live our lives?
Dr. Goran 06:45
Yeah, there’s a variety of different studies, you’ve highlighted one there, which was the study in in rats, that’s not the sole evidence, although for this particular question of whether consumption during pregnancy increases that built-in preference for sweetness that we’re born with that there’s I don’t know of any human studies. So we turn to the animal studies for that particular one question. The studies in humans are so difficult to do, you’d have to like take a bunch of pregnant women to control exactly what the during pregnancy. Is it ethical? Is it even doable? I don’t know, probably not. And then keep everything else constant. And then look at their babies and monitor their babies for the first several years of life and see how their preference changes. That’s a really difficult study to do. There’s some fragments of those types of studies that are doable. So what we have to do in this situation is take the whole collection of evidence from rats from humans, cohort observational studies, to try and piece together a story. Actually proving the causation in this any particular situation is so difficult, especially for these long-term studies involving pregnancy exposure, through to infant and childhood development, is just really, really challenging, if not impossible, so we have to use a variety of different approaches to pull together the data and try and come up with a story that matches the findings.
Jen Lumanlan 08:18
Okay. All right. And so I think that’s sort of a theme that we’re going to come back to throughout the conversation here. And so moving on to fructose, I wonder if you can, firstly, tell us what is fructose and how is that different from glucose and other forms of sugar that we’re ingesting. And where do we find it? Where does fructose show up?
Dr. Goran 08:37
Okay, so in terms of the structure, so ordinary sugar, sucrose, white crystal stuff, it’s a type what we call a disaccharide is two smaller sugars joined together. One of those sugars is glucose and one of those other sugars is fructose. That’s the sugar in cane, in beats, and many other places. It’s most predominant. Glucose and fructose are almost very similar. They’re both have the same chemical formula. Those chemistry fans out there C6H1206. One thing is different though, which turns out to be critical, the glucose is shaped like a hexagon And the fructose is shaped like a pentagon. Soon as you consume that sucrose, glucose and fructose break apart and the different destinies the fructose is twice as sweet as the glucose. The glucose is the energy that’s used all throughout the body from your brain down to your toes. It drives metabolism, it drives as the fuel of every cell in your body, so it’s vitally important to maintain the glucose levels. Fructose, on the other hand, is not directly used for energy, which is surprising to many people. Almost all of the fructose that gets absorbed in the gut gets taken up by the liver. The job of the live, is to filter everything that gets absorbed by the gut and remove it— drug, toxins, bad chemicals, alcohol, add to that list fructose. The liver filters out the fructose because it doesn’t want the fructose getting to the rest of the body. There has to be a reason why. And what does it do with that fructose, it converts it to fat. And that metabolic process is the same as what happens with alcohol and it’s very inflammatory. That’s what produces some of the inflammatory response to sugar. And that fructose can get stuck in the liver and caused by a liver disease, which wasn’t even a disease 10 or 15 years ago, or those fats can be exported back into the blood and caused dyslipidemia, which is the preclinical marker for cardiovascular disease. And that’s why we see a relationship between sugar consumption and heart diseases because of the fructose being converted to lipids in the liver. So it’s not just about the calories, it’s about what happens to those different chemicals that get absorbed and how how they’re different. That’s a long answer to the first part of your question.
Jen Lumanlan 11:04
Wait, which was actually a very, very step by step and helped me to visualize it. So thank you for that.
Dr. Goran 11:10
So visualize those molecules is a good way to do it. And the second part of the question was, where do we find fructose, right? So, so ordinary sugar is half fructose, like I just mentioned. And then there’s some sugars that are even higher and fructose, high fructose corn syrup being the most infamous, which most people are now quite familiar with, and know what to look out for and know to avoid. But there’s other sugars that are just as common, if not more common, that are even higher in fructose. Some of the fruit sugars, for example, so fructose is ordinarily the predominant sugar in fruit, which usually sets off alarm bells for many people, based on what I just said, they’re thinking, “Oh, I’m putting two and two together he did he just say we shouldn’t eat fruit?” And that’s not what I said. Okay. Because we’ll talk about this. Also, eating fruit is very different than extracting the fructose from the fruit and concentrating it, which is what happens in fruit sugar. So fruit sugar, which is very popular sugar now is basically taking that fructose out other fruit and boiling it down, just like you take the sucrose out of the cane or a beet and make a sugar out of it. The same process, you take the fructose, so you’re talking now about concentrating that sugar, which is predominantly fructose. And then can ingesting it. But instead of calling it high fructose corn syrup, we call it fruit sugar. But it’s even higher in fructose.
Jen Lumanlan 12:43
Yeah, okay. So thank you for that. Now, I think we have a clearer picture of what it is and where it comes from. And so now let’s go into what effect that has on the body. And you’ve mentioned a couple of ways, and I want to dig into some of those. One of the studies that you looked at, had volunteers consuming two different varieties of Dr. Pepper in a random order. One was made with regular sugar, which I think must have gotten direct from the manufacturer, the paper said because it’s hard to find on the shelves, and one way with high fructose corn syrup, and testing the blood of the volunteers after a period of several hours and seeing how much fructose is circulating. And it seems fairly clear that there was more fructose circulating among the people who had consumed the high fructose corn syrup. And then I’m just trying to go from there to “Okay, so what does that mean?” Because the research that I was able to find was seemed really mixed in terms of whether diabetes precedes high blood pressure, whether high blood pressure precedes diabetes. And, of course, I’m not an expert on this topic, uric acid, I felt as though I was definitely over my head but the meta-analyses seem to indicate that the message that lower is always better is potentially not the complete picture. I wonder if you can help us understand what do you make of this body of work around the effects that high fructose corn syrup and fructose specifically has on our bodies?
Dr. Goran 14:03
Yeah, well, actually, this is one situation where we do have pretty clear causative evidence because people have done detailed feeding studies in humans, not just a Dr. Pepper study, which by the way, didn’t just show higher circulating glucose levels, but the high fructose corn syrup Dr. Pepper group had, I believe, increases in blood pressure and blood lipids. But that’s just one study. Others studies, including Kimber stanhope from UC Davis, has done some of the best studies where she essentially does what I described before except not in pregnant people, takes adults locks them up for several weeks, and feeds them known foods, so it’s a captive audience. So it’s a bit like a rat in a cage, but that’s the closest we can do, and we know exactly what they’re consuming in her studies in which she has fed bearing in ounce of fructose, including a dose-response study, where and she showed quite clearly that it’s excess fructose in a dose-response manner, not excess glucose that causes things like fatty liver, dyslipidemia, uric acid build-up, which, by the way, where does that come from? That’s a byproduct of how fructose is metabolized in the liver and can contribute to inflammation and blood pressure. So this is actually quite clear evidence now, and the link is clearest with those cardiovascular endpoints, and the inflammatory endpoints, and the fatty liver endpoints.
Jen Lumanlan 15:42
Okay, perfect. So that’s really helpful to understand. And then moving on from there, I was really surprised to get to the end of the book and find that so many of your recipes involve using dried fruit as sweeteners given that we now know that fruit is high in fructose, and no, we’re not again saying people shouldn’t eat fruit. But that dried fruit is a highly concentrated form of supply of fructose. Can you help us to see why you’re recommending using dried fruit as a sweetener? When we see that fructose is something that we potentially should be consuming less off?
Dr. Goran 16:13
Yeah, well, we want it to come up with creative strategies as alternatives to added sugar. And one way to do that is to kind of take advantage of the natural sweetness. And nothing in this world is perfect, because you’re right, it’s there’s still sugar in those dried fruits. So let’s say they’re not even dried, let’s say, it was like a banana, so for example, our sugar-proof blueberry muffins have no added sugar, they’re just sweetened with banana in the background. And I think there’s advantages of that, despite the fact that you are getting some fructose from the sugars in the banana, you can also get all the fibers that are in the banana, all the phytonutrients that are in the banana, the taste of the banana, etc. So there’s lots of other advantages that I would much prefer the natural sweetness and the natural flavor, versus the kind of potent sweetness that you get, just from added sugar. So those are the advantages. And then there are some foods that are higher in fructose, and some that are similar to sucrose. So for example, bananas are pretty even in terms of glucose and fructose, dates, we use a lot or high in fiber, for example. So those are just different ways. We do it to try to minimize the sugar load and get natural flavors and natural sweetness in there as well.
Jen Lumanlan 17:41
Okay. All right, great. And so I know that one of the primary things that parents are concerned about when they think about how much sugar their children are eating is their children’s behavior. And does their behavior change after they eat sugar? And I think you actually worked on a study where you were looking at the behavior of Latino and African American adolescents, and you gave them two different breakfasts one was a pop tart, a piece of string cheese, and orange flavored drink called Tampico. And the other had a whole wheat bagel with margarine and a glass of water with a fiber supplement. And you observe their behavior after they had this breakfast. And I wonder if you can just tell us about what you saw in that study?
Dr. Goran 18:17
Yeah, so this was a study designed to test that question of how children respond acutely to different types of meals, like you just described, one was high in sugar, and one was higher in fiber, and we had them consumed in meal and then put them in a room. Again, again, a bit like putting a rat in a cage, but we put them in a room where they could choose to sit and read or fall asleep or get on an exercise, bike or play video games. So we just observed what they did with the time that they had after the meal. And what we saw was it up to the high sugar meal, kids tended to bounce around a bit more than they were weren’t as stable, and their energy levels, they were a bit more hyperactive first, and then they kind of crashed a little. Whereas the high fiber group were a bit more stable in terms of their energy level.
Jen Lumanlan 19:12
Okay. And I want to sort of key in on what you said about a bit more. And that does seem to be an important phrase here because I think you actually created a new light plus activity category because there was so little moderate or vigorous activity going on. And so I think when parents, particularly my listeners who often have younger children, they’re thinking about sugar, they’re thinking about their kid bouncing off the walls. And that’s really not what you saw here, right? You saw a slight increase in activity, is that right?
Dr. Goran 19:39
Yeah, I mean, again, these are teenagers, which returned to not bounce off walls. And in a very contained artificial environment. So again, it’s not ideal experimentally, or it’s not ideal in terms of trying to get the naturalistic response, but from an experimental standpoint, we wanted to observe them so It’s always kind of a compromise of the pros and cons of doing that. We, for this particular study, made a decision to look at the careful, you know, we wanted to look at them under carefully controlled conditions where we could observe them. So it’s unlikely that those kids followed their normal typical patterns we tried to make available. But again, it’s a very artificial environment. If it was in young kids, yeah, they might have been bouncing off the wall, but again, even for young kids, or any kids or any adult, I mean, I think context and setting are very important in terms of how you respond to food. And so it’s very hard to simulate that in an experimental condition because how we respond to any input of food or stress or anything we put into your body, I think the response to that I think we all realize, is very contextually driven, in terms of where we are setting and who’s around us, and other factors as well.
Jen Lumanlan 21:01
Yeah, okay. And then continuing on that theme. There was another study that looked at children who were given orange juice sweetened with sucrose, so that they were either getting orange juice by itself, or orange juice that was sweetened with sucrose and 40 to 45 minutes later, the children who had the additional sweetener were less able to sit still in class had more inappropriate behavior, more difficulty concentrating, but even the children who had the just the regular orange juice to consume sucrose, right, and so and I think also, you had mentioned just a little bit further in the book about how artificial sweeteners can have a very similar effect on the body. And so I’m trying to understand what can we actually understand from a study where children are given two different amounts of sucrose rather than I know, a lot of these studies will give a child something that’s sweetened with sucrose or something it’s sweetened with low-calorie sweetener and make that comparison, which introduces its own problems. Where can we truly understand about children’s behavior from after they’ve consumed sugar and low-calorie sweetener, and no sweetener at all?
Dr. Goran 22:00
Yeah, I mean, again, the studies are difficult to do and hard to come by. So not a lot of people have studied this, most of the studies which were reviewed and studied, some years ago, I think, almost 20 years ago, reviewed the evidence, and predominant studies in this area compared regular sugar with an alternative sweetener, like sucralose. So it’s not the best comparison. As you mentioned, there is no great perceivable in his particular situation. So I think, again, this is just one part of the story, we need to look at the totality of the evidence and ultimately, for me, doing the research on the book, by the way, in all these studies we’re talking about, these are from the literature, not all our studies, very few of them are studies. But looking at the totality of the evidence, I was struck by some of the larger studies that look at the functional outcomes. So we can argue about whether there’s an immediate response to sugar. Most parents will tell you, yes, there is a response to sugar and my kids get hyperactive and bounce off the wall if we give them too much sugar. But what about the actual outcome? And so studies have shown, for example, that kids who consume more sugar have lower test scores, don’t perform as well in class, and have poor outcomes. Those to me were very striking, again, there’s not a lot of studies in that area, maybe one or two, but the results were quite clear and more convincing. So again, you got to look at the totality of the evidence of all those paradigms. The immediate effects on the brain, the short-term effects on behavior, and the longer-term effects on functional outcomes. What’s the overall story that we can conclude from the totality of the evidence?
Jen Lumanlan 23:45
Yeah, okay. So I would like to get into the cognitive aspects as well. And I wonder if before we can leave the behavior aspect behind? You know, I think that a lot of parents will say that if you ask them, yes, my child has a big response when they sugar. But of the parents that I work with, I would say that there’s also sort of an almost a sort of blinders on this is what I’m seeing in the moment, I just gave them sugar, this must be responsible for their behavior. And they don’t necessarily take into account the fact their child didn’t sleep well, last night, or they went to bed super late the night before, or they had a squabble with their sibling that morning, or there’s some other thing brewing and like you said, this context is super, super important. And so I’m wondering if advising parents to maybe keep a journal of their child’s sugar consumption, and if there are a lot of parties going on in a week or something keeping track of bedtimes and what else is going on in the child’s life, so that no matter what any particular study says about, you know, those 40 kids sugar consumption, that you can have a true picture of what’s going on with your child, that it takes all of these contextual factors into account and doesn’t just look directly at Sugar. Is there hyperactivity or not? Would you recommend doing something like that?
Dr. Goran 24:54
Yeah, we do. And that’s exactly what we do in part two of the book when we guide for families to our seven-day challenge where we say, okay if you’re not convinced, let’s do an experiment and see what happens when your kids are off of sugar. And you can see for yourself and record the changes. And I think we have to self-experiment in our families and be family scientists because it’s so variable. And even day to day, I mean, studies have shown day to day the blood if you take kids or adults, and give them the same exact dose of sugar, day to day, the variation in blood sugar will be quite variable. So that’s pretty telling, and so, you know, it’s the same with diets. I’m not going to say there’s any one particular diet that works for everybody, there’s isn’t. I think everybody’s different. Everybody’s context is different day to day and it’s not quite as simple as saying any one thing, but I will say, I’d strongly believed that’s why I wrote the book that no matter where you are, what you say, reducing sugar is going to be helpful. So that we know and that is something that we’re working towards. So, you know, we can discuss the science and terrible, you know, focus in on experiments and find the pitfalls and limitations, which is, you know, great exercise, but at the end of the day, reducing sugar is going to be helpful.
Jen Lumanlan 26:21
Yeah, okay. So you mentioned cognitive development, and I thought that the book was pretty provocative on that topic. And so you said, if you can look at the brains of healthy adults who typically drink one or two sodas per day and compare them to the brains of people who drank less than one per day, you would see something astonishing. The brains of the group drinking sugary beverages would be smaller, to put it bluntly, new research shows that too much sugar shrinks your brain. And yeah, that was absolutely confirmed in the study that you cite. But it’s a really a small amount, and it ended up actually not being significant after adjusting for other dietary factors and physical activity. And so I’m trying to see, is it the sugar that’s really driving this? It is the reduction of volume of the brain enough to make a difference and should we be really concerned about it?
Dr. Goran 27:10
Yeah, it is provocative, and it’s a what was a one or 2% shrinkage of the brain? I don’t want. Yeah, but I don’t want my brain shrinking by any amount, really. And, again, it’s about the totality of the evidence, we know sugar affects the brain in different ways. We just published a paper showing how big it was a study of one-month-old babies and their brain structure, and looking at how it was different in babies born to mothers who consumed a lot of sugar during pregnancy. And we saw a lot of differences in their brain organization. And what that actually means in terms of functional outcomes in those babies, I don’t know, because we just studied them at one month of age. But we do know that sugar affects the brain in many different ways. I think that’s probably factual and difficult to argue with. Does it shrink the brain and citing one study that shows a 2% shrinkage of the brain. Like you said, some of that is explained away by other potential confounders. So that’s not the be-all and end-all of the story. That’s just one particular study. Yea, on top of many other studies.
Jen Lumanlan 28:21
Yeah, okay. And how much of this do you think, is a factor of sugar, and how much is associated with things like socioeconomic status, which tends to be a confounder on the kinds of tests where we are testing people’s cognitive performance? And we know that that is intimately wrapped up in what people are able to afford to eat. And I’m wondering if it’s linked to larger issues related to the kinds of choices that people who don’t have a lot of income have related to the foods that they eat, compared to, specifically sugar consumption?
Dr. Goran 28:55
Yeah, that’s such a great question, Jen, I mean it’s so hard to separate out these different factors, which are intricately related in terms of our lifestyle and our effects. So trying to separate them is really difficult, you know, we can statistically adjust, which, you know, has its pros and cons, we can do studies in different segments of the population who are eating different diets, we can control diet. So I mean, again, it’s the same issue, we have to use different approaches to try and unravel the complexity of all these different factors that are injured, connected. And doing that in humans who are living different lives in different situations is extremely difficult and extremely challenging.
Jen Lumanlan 29:42
Okay. And then towards the end of the chapter on the cognitive issues associated with drinking sugar you talk about decision-making, and whether sugar affects people’s ability to make what are rational, good decisions as it were. In citing a study, I think of one of your colleagues of people who had just fasted for, adolescence who fasted for 12 hours, and then were given a chance to choose a food to eat, that they really enjoyed, or get a monetary compensation a month later for, I think, from what I could tell from the study, it was basically what the slice of pizza was worth a month later. And the ability to say, “No, I don’t want the pizza and I’d rather have the $2 a month,” later was seen as proof of the ability to delay gratification. And you know, we’ve done a whole episode on the marshmallow test and again, linking that back to socioeconomic status, because that’s really the biggest correlation between ability to delay gratification is with socioeconomic status. And so you say in the book by giving kids less sugar and especially as fructose, we can promote the healthy development of their reward centers, which ultimately help them make better decisions. And I’m trying to see the evidence for not just the decision-making in the moment, but the development of those decision-making centers in the brain and the connection to fructose, and I’m not quite able to make the connection. What am I missing here?
Dr. Goran 31:01
I don’t know. Again, it’s just a very complex picture, in terms of trying to unravel all those things. I think delayed gratification, serves a lot of different important, predicts a lot of important outcomes, that one particular study, and I don’t know a lot of other studies related to sugar. And was that, you know, some of these studies better than I do sounds like you’ve done your homework. This is great. Yeah, in particular, I’m trying to remember was that study, cross over or not, because the best better way to do to control for the socio-economic thing would be, I think, to have kids undergoing different conditions, and then you control for it. But I can’t remember if that study was possible.
Jen Lumanlan 31:45
I don’t remember for sure. And I didn’t write it down in my notes. So, I don’t remember for sure.
Dr. Goran 31:52
Okay. Well, I’m hoping it was crossover.
Jen Lumanlan 31:55
So that one day they would get the sugar and the other day, they wouldn’t get the sugar. The results were in each case, yeah, I don’t remember that being the case. And I’m wondering if that would work, because then they would know, sort of the outcome, like, the thing that they were going to be asked at the end is, would you prefer the money or not? And I wonder if they would adjust their response based on what they said.
Dr. Goran 32:17
Again, experimental, you have to you have to do your best, so yeah, you know, in that situation, you would randomize the order the conditions are given, which is a way to try and overcome that limitation.
Jen Lumanlan 32:28
Okay. All right. And so coming out of all of this, your overall impression is based on the body of research is that consuming a lot of sugar, and particularly, a lot of fructose is not good for children’s bodies and brains. Is that an appropriate way of characterizing your overall opinion?
Dr. Goran 32:48
Yeah, and just making that a bit more nuanced is to say that the outcomes may be even worse than children because of the developmental aspects that their brains are growing, their guts are evolving, and livers are developing. And during that developmental process, the adverse effects of sugar may be even worse and longer lasting.
Jen Lumanlan 33:11
Yeah, okay. So from there, we start to talk about, well, what is an appropriate amount of sugar to be ingesting? And I know that the World Health Organization has guidelines, but reading through the guidelines, it seems as though they are really looking at the evidence and saying, well, the evidence here is actually not very high quality, the evidence that they reviewed, and they have produced a recommendation to limit free sugars to less than 10% of total energy intake. And the evidence is based on moderate quality evidence. And they’re mostly looking at what they call dental caries. I’ve never heard the word caries before, but I understand is a synonym for cavities. And so what they’re saying is that you should eat less sugar and the primary reason you should do that is because it’s gonna give you dental cavities, there’s really the World Health Organization does not base this recommendation on any other health aspects related to sugar intake. And then they go on to recommend a suggest a recommendation of 5% of your caloric intake should be from sugars based on quote, very low-quality evidence from ecological studies, again, related to dental cavities. So I was super surprised to see what they’re calling moderate and low-quality evidence entirely related to dental cavities, and then go on to see this pretty stringent recommendation. Do you know anything about that recommendation process or what happened there?
Dr. Goran 34:28
That particular recommendations you’re talking about from the World Health Organization, I think it’s over 20 years old now. And there have been a number of different recommendations since then, that have expanded the evidence base beyond dental disease. Most recently, for example, the American Heart Association has come up with recommendations based on a lot of the connections that we talked about related to sugar and cardiovascular disease. And they give limitations on added sugar and an even more recently, as recently as January of 21, the USDA that new dietary guidelines for America came out with a new recommendation which we proposed in sugar proof, which is zero added sugars for between zero and two years of age. That’s a brand-new recommendation. I mean, so this is a fast-moving field of research. Changing the new dietary guidelines also go along with the previous one said 10% of added sugars. They didn’t go to 5%, but they did say less than 10%, and their evidence base includes a lot more than just dental disease, that the USDA to really broad review, and many people were upset that they did not go to 5%, or I think saying less than 10% is still pretty good based on the evidence, which is much broader than it was for that World Health Organization. Recommendation that you mentioned.
Jen Lumanlan 36:05
Okay. Great. Thank you for pulling that additional context in. And so that’s if we’re looking at 5%. Just starting there, that’s about 25 grams of sugar for a child, is that right? Approximately?
Dr. Goran 36:16
Well, the same for children is hard because it changes with age, children eat different amounts based on their age, in sugar proof, we came up with an age-specific recommendation, up to 18 years of age.
Jen Lumanlan 36:30
Yeah, and stepping that up in stages. And I guess where I’m trying to go with this is that one of my listeners in particular that she’s seeing these World Health Organization recommendations and some of the more recent ones too, and thinking okay, yes, if the World Health Organization says this, we’re going to do this, and then just how to put it into practice, because as you said, it is everywhere. You know you eat ketchup with your fries, and you’re done—half of your calorie consumption of sugar for the day is done. And so what hope is there all of us being able to actually really live by the standards, eating in the real world, unless we are so enormously privileged that we can prepare all of our own foods from scratch; we have the time, we have the money to be able to buy all of these fresh fruits, and do it from scratch. Can people who live in the real world actually comply with these recommendations do you think?
Dr. Goran 37:24
I think is very challenging. I mean, you make an excellent point, I think there’s a complete mismatch between what these major health organizations are advocating for and what the food industry is producing. So this is a problem because it’s not a lot of added sugar, so what we’re talking about here is added sugars. Not all sugars. So there’s no limits on fruits and vegetables, and the natural sugars that are in dairy milk and cheese, and so on, but we have to look out for is added sugars. And so I think there is places to start by being smart about choosing brands that have lower or zero added sugars, so you mentioned ketchup, not all ketchup has added sugars or ketchup brands with zero added sugars, same is true for peanut butter, tomato sauce, yogurts, and so on. So that’s one place to start. I think a big source of added sugars are in liquid form; sodas, juices, energy drinks, and so on. Juices are interesting, by the way, because the sugars in juice would be included in the World Health Organization’s definition of free sugars, but the sugars in juice are not technically included as an added sugar according to the USDA. I would argue with that. I go along with the free sugar idea because in juice, the sugars are liberated. Drinking a glass of juice is very different than eating an apple, so I would count those sugars in juices. So to come back to your question, look out for the added sugars and try to eliminate liquid sugars. Those two alone will make a big dent so that you do have room to enjoy added sugars.
Jen Lumanlan 39:13
Okay. And we had a call yesterday with the members of my community who were participating in this project to read the book and take on the ideas from the book and see what impact it has on our families. And a couple of ideas came up in that conversation. And we had mentioned freezing bananas with a stick inside as a lollipop and then you had mentioned freezing a bit of watermelon on a stick as a lollipop. And we’re definitely going to try that. And the idea also came up when a child wants to have something that has sugar in it to balance that out with something that has complex carbs and fats in it that help to smooth out the intake of sugar into the blood. Can you tell us about your breakfast experiment and what parents can take from that in terms of ‘we’re not going to give up sugar entirely,’ but what does that mean for how we can take on sugar that actually is really important as well.
Dr. Goran 40:03
Yeah, I think yeah, so breakfast is typically a source of a lot of sugars and can set the day off into like a, what we call the sugar rollercoaster because when sugar is high at breakfast, it tends to be short-lived, It provides a rapid spike of energy. And that energy can fall and then you get hungry and you want more. So the idea is to try and start the day off with a stable blood sugar. And so in the book, I talk about an experiment I did wearing a glucose monitor, where you can monitor your individual response to blood glucose, showing, for example, I had toast on eggs—my blood glucose stays pretty flat, whereas if I have jam on toast, it goes way high, and stays high throughout the morning. And that can be problematic. But there’s a number of simple tricks and hacks you can do to still enjoy toast in the morning, if you like that, which I do, depending on what you put on, it doesn’t have to be jam. So by combining different foods and different nutrients, you can offset those glucose spikes, so the idea is to try and minimize them. So let’s say you’re making pancakes, for example, you can game the system by adding an extra egg whites—up the protein. You can add some flax seeds or some chia seeds or hemp seeds to up the fiber, and probiotics. And you can serve it with fresh fruit or with yogurt doesn’t have to be served with syrup or maybe a little bit of syrup, if that’s what you like. But the point is, there’s multiple ways to do it to game the system towards upping the nutritional quality by breakfast time. And studies have shown for example, also that if kids have the choice between a high-sugar breakfast cereal and a low-sugar breakfast cereal, they’re often just as happy with the low-sugar breakfast cereal, especially if they can talk to it up themselves by let’s say, throwing some berries on there or throwing some flaxseed on there, for example. So there’s different ways to mix it up to basically make your own with your own version to up the nutritional quality of the typical items.
Jen Lumanlan 42:16
Okay, and something that I’ve noticed, as we’ve been doing this. And I think other parents may as well is that our children, when we say, “Okay, we’re going to do this experiment to eat less sugar and see how it impacts us,” that they tend to then gravitate towards the simple carbs. And so we might see this that if we had previously been eating toast and jam for breakfast, that now they just want toast and butter. And so maybe the fat is helping with that a little bit, but if they’re just eating sort of plain white bread, which I think is broken down in the body in the same way as it’s all sugar, it’s because it’s carbohydrates, it’s broken down into sugar, that we might think, “Well, I’m not eating the jam and so I’m getting a lot less sugar,” when actually, our body is not seeing it in that same way. Can you help us to understand why you don’t explicitly advocate for consuming less simple carbs? And I’m not saying we shouldn’t eat any carbs at all, because our bodies need sugar. But why don’t you advise us to eat fewer simple carbs?
Dr. Goran 43:15
Basically just because of what you describe, because simple carbs are rapidly broken down into sugars. So white bread is made with white flour, which is basically a big long chain of glucose molecules, and the body is very efficient at chopping up that white bread into little glucose molecules. So if you suck on a piece of white bread will soon very quickly taste sweet.
Jen Lumanlan 43:39
I was shocked by that experiment.
Dr. Goran 43:43
So you know, there’s a hierarchy, so you can have a piece of white bread with jam, that would be like the worst. And then you can have white bread with butter, which is okay because you’ve eliminated the Jam, you’ve done a lot better. But then you can go to a more processed bread, brown bread or made with a less refined carbohydrate, or even sourdough bread, which some studies show is less glycemic. So there’s hierarchies to all these things, which you can gradually improve the overall outcome and dampen the glucose response. And then you can put nut butter on it, for example. So you get more protein or something with a bit more fiber which can be even better. So there’s multiple ways to do it.
Jen Lumanlan 44:29
Okay. And I think related to that is the idea of smoothies. And the kids are often quite willing to accept fruit in smoothie form that they may not necessarily accept in whole form. But I know that when you eat a whole fruit, you get a whole bunch of benefits that you don’t necessarily get from drinking it in even the same fruit. You’re breaking down the fiber and you can potentially not register it as chewing as eating and still feel hungry after it. Do you recommend smoothies consumption on a regular basis as a way of getting fruit intake if we’re not eating much fruit right now? Or would it be better to eat the whole fruit if we can?
Dr. Goran 45:09
I think both are good. For sure. I think we should be eating whole foods multiple times a day, if possible, not a lot all at once, that can be problematic. But smoothies are fine, too. I don’t understand the concern over the shearing of the fibers and association and so on. But everything in life comes with pros and cons, and I’m willing to take the pros because I can make my kids a smoothie, or now they’re old enough to make it themselves, so they know that they can get a good dose of fruits, they can add some decent sources of fiber in there, they can put some nut butter in there to get some protein, they can limit the added sugars in there. So I’d much rather, they did that than went out to fast food place and got a smoothie, or a milkshake, which is just basically loaded with sugars, or even if they bought a smoothie at the grocery store. So again, there’s a hierarchy with all of these things, in terms of you know how you do it, you can blend it less so the fibers aren’t sheared, you have control over that. So what I like about this smoothie is you’re in control of what goes in there, and you can load it, you can game it in your favor.
Jen Lumanlan 46:24
Okay. And so as we come to a conclusion here, I wonder if is there an overall message that you’d like to leave with parents to help them see a path forward on this, in terms of what the research says about how sugar impacts our children’s bodies, and what we should do about that?
Dr. Goran 46:40
Yeah, I think it’s, you know, there’s no easy solution. And I think there’s a lot of misinformation and a lot of confusion. But I think we all just have to do the best that we can with what we’ve got, and try and you know, just be informed about the different effects. And I think no matter where you are on the spectrum, I think there’s going to be benefits. And no matter where you are, I’m believing the science or not. And we’ve had a great discussion on the pros and cons of some of the studies, which is, you know, I think very healthy and very fun. But no matter where you are in those spectrums, I think at the end of the day, you’re still going to get benefits by reducing sugar, I think it would be really hard to argue against that. Reducing sugar, increasing fiber, increasing protein, increasing more fruits and vegetables, just kind of don’t lose sight of those basic principles, and try and apply them to whatever your situation is that you’re dealing with because everybody’s situation is very different. Just don’t lose sight of those basic simple principles.
Jen Lumanlan 47:44
Great. And you the beginning there, you mentioned misinformation and immediately caught my attention. And I’m wondering, are there particular ideas that you see circulating around that parents might have heard that you would classify as misinformation?
Dr. Goran 47:58
Yeah, maybe once in a while we get just being involved in last year on social media has kind of opened my eyes to some of the information, so for example, I eat a lot of eggs. Some people think eggs cause cancer or eggs cause heart disease. I had another discussion with somebody about skimmed milk being white soda, that skimmed milk was nothing more than white soda. These types of things are, yeah, there are studies, there are some studies for eggs and the science changes in terms of eggs being good or bad. And at the end of the day, you have to kind of balance it all out. I like eggs, I like the taste, I enjoy eggs, and I keep track of my blood cholesterol is not going up. It’s fairly stable, although I’m personally on a statin because I have high LDL cholesterol, but I do keep track of it. So I think at the end of the day, that’s what I mean by you have to just take the information that we have and apply it to a particular situation and keep track of things to see how it’s affecting your health.
Jen Lumanlan 49:05
And hopefully having the healthcare access to be able to do that in a way that that you can see if there are real negative consequences happening beyond the ones that you can actually observe with your eyes.
Dr. Goran 49:16
Yeah, I mean, that’s a really important point that you kind of alluded to there that, really, and this is the focus of my research is on those the segment of the population that does struggle most that doesn’t have access, that doesn’t have access to healthy foods necessarily or to track their health. And so the disparities in this field are huge and underappreciated. And we get very bogged down in a lot of the detail, preaching to the choir to a certain extent, whereas I think the real reality is the big problem here are the disparities that exist in nutritional health and nutritional outcomes, you know, if I had to hold the power I could. That’s what I would be trying to change is trying to flatten out some of those inequities and disparities.
Jen Lumanlan 50:10
Yeah, yeah, I actually spoke with Dr. Karen Throsby yesterday, and she’s a sociologist and her episode will probably be released after yours. So listeners will hear this one first and then hers for additional context. And yeah, she was absolutely saying that we tend to focus on these individual topics because they’re palatable, they’re politically okay to discuss, whereas effecting broader scale inequality, racism, access to health care, you know, nobody wants to touch it. And it’s much easier to tell certain groups of people what to eat than it is to talk about how do we not have poverty anymore so that people can make the choices they want to make about the foods that they eat.
Dr. Goran 50:50
I mean, that’s where the predominant problem lies in terms of nutritional disparities and health outcomes related to that poor nutrition. We have to get to SNAP and we have to get to WIC because there’s big problems with those federal programs.
Jen Lumanlan 51:08
Yeah, and for listeners outside the US, those are programs that help families who don’t have a lot of income to afford groceries. And so, yeah, so a bit, lots of challenges in the world. And what we’re working on the ones that we can at the moment. So thank you so much for being here and for helping us to get into the weeds on the research, which I enjoy and I’m glad that you were able to help us to really understand a little bit more about what those studies say. And then also speak to what that means practically for how we can live ourselves and eat ourselves and also raise our children for the best possible start they can have in life. So, so thank you for being willing to talk through that with us.
Dr. Goran 51:47
My pleasure. It’s all ear.
Jen Lumanlan 51:51
Yeah, absolutely. And so if you’re watching on YouTube, Dr. Gordon is holding up a copy of his book called Sugar Proof and there’s a link to that on our page, where the episode is and as well as links to all of the studies where you can dig into the research that we’ve dug into as well today. And you can find all that at yourparenting mojo.com/sugarproof. Thanks for joining us for this episode of Your Parenting Mojo. Don’t forget to subscribe to the show at yourparentingmojo.com to receive new episode notifications, and the free guide to 13 reasons your child isn’t listening to you and what to do about each one. And also join the Your Parenting Mojo Facebook group. For more respectful research-based ideas to help kids thrive and make parenting easier for you. I’ll see you next time on Your Parenting Mojo.
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