On average, Americans consume about 20 teaspoons of added caloric sweeteners daily.1 This is two to three times the recommendation from the American Heart Association, which suggests that most women consume no more than 100 calories of added sugar (about 6 teaspoons) per day, and most men consume no more than 150 calories of added sugar (about 9 teaspoons) per day.2 Increased intake of added sugars can have a negative impact on health, including decreasing HDL-cholesterol levels and elevating triglyceride levels.3
Helping patients reduce their intake of added sugars can be a struggle, especially during the holidays if they experience frequent food cravings. However, food cravings themselves may be brought on by the meal choices your patient makes. One study compared brain activity following consumption of a high glycemic index meal, such as a meal rich in added sugars and refined grains, to consumption of a low glycemic index meal. Eating a high glycemic index meal resulted in lower blood glucose and increased hunger, and stimulated the regions of the brain associated with reward and cravings in the late postprandial period, which could impact food choices at the next meal.4This finding points to the possible value of helping our patients reduce the glycemic load of meals in an effort to help increase satiety and reduce overall cravings. The good news is, working to lower the glycemic index through simple substitutions, such as swapping brown rice for white rice, may be a tool to help manage the spikes and dips in blood sugar that may occur from more refined, starchy carbs.
Researchers are also exploring the role of added sugars in leptin resistance.5Leptin, a hormone released by fat cells, helps signal the brain to decrease food consumption and increase energy expenditure. Leptin resistance has been referred to as the hallmark of obesity.6 A recent study found a significant correlation between plasma leptin levels and carbohydrate cravings.7 This may be especially valuable information for those with diabetes or prediabetes, as insulin resistance has been associated with leptin resistance.8
To help curb cravings this holiday season, one strategy may be to work with your patients to help them reduce the overall glycemic load of their meal choices, while simultaneously working with them to reduce intake of added sugars. This combination may help fight cravings, as well as manage hunger. As mentioned earlier, certain meal swaps may help reduce the glycemic load and limit added sugars without sacrificing flavor. For instance, work with your clients to find whole grain alternatives to common refined grain choices such as whole grain pasta over white pasta or steal cut oats over instant oatmeal. Added sugars can also be reduced by making simple swaps, such as seltzer for soda, 100% juice for fruit juice, and unsweetened teas for sweetened varieties.
Making a few easy swaps to meals and snacks may help boost satiety, rather than stimulate cravings. When our patients’ cravings are diminished, the goals of improved blood glucose management and reduced body weight may become easier to work towards, and our overall health may be enhanced.
1. American Heart Association. 19 May 2014. Frequently Asked Questions About Sugar. Retrieved from http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyDietGoals/Frequently-Asked-Questions-About-Sugar_UCM_306725_Article.jsp#.Vk4AKBNViko
2. Johnson R, et al. Dietary Sugars Intake and Cardiovascular Health. A Scientific Statement From the American Heart Association. 2009. http://circ.ahajournals.org/content/120/11/1011.full.pdf. Accessed November 10, 2015.
3. Welsh JA, et al. Caloric sweetener consumption and dyslipidemia among US adults. JAMA. 2010 Apr 21;303(15):1490-7. doi: 10.1001/jama.2010.449. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3045262/
4. Lennerz BS, et al. Effects of dietary glycemic index on brain regions related to reward and craving in men. Am J Clin Nutr. 2013 Sep;98(3):641-7. doi: 10.3945/ajcn.113.064113. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743729/
5. Shapiro A, et al. Prevention and reversal of diet-induced leptin resistance with a sugar-free diet despite high fat content. Br J Nutr. 2011 Aug;106(3):390-7. doi: 10.1017/S000711451100033X. http://www.ncbi.nlm.nih.gov/pubmed/21418711. Full text accessible at http://journals.cambridge.org/download.php?file=%2FBJN%2FBJN106_03%2FS000711451100033Xa.pdf&code=b39b75fcef66d9e30244640216120c97
6. Lustig RH, et al. Obesity, leptin resistance, and the effects of insulin reduction. Int J Obes Relat Metab Disord. 2004 Oct;28(10):1344-8. http://www.ncbi.nlm.nih.gov/pubmed/15314628
7. Licinio J, Negrao AB, Wong ML. Plasma leptin concentrations are highly correlated to emotional states throughout the day. Transl Psychiatry. 2014 Oct 28;4:e475. doi: 10.1038/tp.2014.115. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4350520/
8. Fischer S, et al. Insulin-resistant patients with type 2 diabetes mellitus have higher serum leptin levels independently of body fat mass. Acta Diabetol. 2002 Sep;39(3):105-10. http://www.ncbi.nlm.nih.gov/pubmed/12357293