by Dr. Will Cole

Sugar: We love it. We hate it. We fear it. We think we can’t live without it. If you have a sweet tooth, you are among friends, whether you lean towards chocolate or bakery items or grapes and bananas or even pasta and bread. My job as a functional medicine practitioner is to get to the root cause of health issues, and the quest for sweetness can be a significant factor in losing weight, balancing mood, and gaining freedom from food addictions. Sweetness isn’t all bad, but it can definitely trip you up, and I get a ton of questions about sugar – over 500 at last count! I’ve handpicked a few that appeared over and over and will answer them here. Without further ado, here’s the 411 on all things sweet and carby:

1. How many grams of sugar per day is healthy to consume? (including naturally occurring fruit sugars & milk sugars)? – Nicole from Buffalo, NY

That depends on a few factors.

  • The source of your sugars.
  • Your individual tolerance to sugar.

Not all sources of sugar or carbohydrates are created equal. Are you getting your sugar from sugar-infused “created foods” like candy, or from more nutrient-packed foods containing natural sugars, like sweet potatoes, berries, or whole-milk yogurt. You may have heard that sugar is sugar, but I disagree. Fiber and nutrients modify the damaging effects of natural sugars.

There are two ways to measure carbohydrates. Net carbs include all sugars minus the fiber content of the foods that you are eating. Total carbs, on the other hand, counts both soluble and insoluble fiber. Insoluble fiber can’t be absorbed by the body and therefore has minimal, if any, effect on your blood sugar. Insoluble fiber has actually been shown to lower blood sugar levels, so it seems silly to include it in your count. For most people, sticking to whole-food sugars and limiting added sugars keeps them in a good range. I recommend clients try to stay below 50 grams of net carbs a day of both added and naturally occurring sugars.

Beyond the numbers, each of us has a different tolerance to carbs. Some people can eat a diet based on whole-food carbs such as fruits, vegetables, and cold-pressed juices, and do great! Others might need to moderate their sugar intake a bit more to reach a state of optimal health. I always recommend really checking in with your body after consuming high-carb or high-sugar foods and seeing how you feel. Do you feel strong and energetic, or sluggish and grumpy? That can tell you a lot about your individual tolerance. Either way, whenever you eat carbs or sugar, mitigate their impact by consuming them with protein and/or fiber.

2. How does sugar affect hormonal balance? – Melissa from Austin, Texas

Sugar has a clear and definite effect on hormonal balance. Insulin (a type of hormone) works to regulate blood sugar and bring it down back to normal after ingesting any type of sugar, whether it’s added or naturally occurring. In its normal-functioning state, the release of insulin is a healthy, necessary response – it’s when you eat too much sugar and flood your body with insulin that things get out of whack and your blood sugar doesn’t go back to baseline as quickly or easily. When your blood sugar is chronically unbalanced, it can directly affect the HPA (hypothalamic-pituitary-adrenal) axis, which controls your body’s release of cortisol and leads to feelings of stress and adrenal fatigue. When your blood sugar is high, cortisol is also high, and that chronic elevation is one of the top contributors to adrenal fatigue. Excess sugar is also inflammatory, which further feeds hormonal imbalance.

3. There is a lot of controversy about “natural” sweeteners such as honey, maple syrup, molasses, agave, and stevia. Are these sweeteners safe? – Leah from Denver, CO

Honey, maple syrup, molasses, dates, and fresh fruit juice are some of the best sweeteners you can use because they also contain beneficial nutrients, but even these should only be consumed in small amounts. Stevia, xylitol, and monk fruit are also fine low-carb options for sweetening, but in excess they can cause some digestive symptoms like bloating. The key with all sweeteners is moderation! If you really need something a little sweet, add a little, but don’t go overboard!

4. How do you know if your blood sugar levels are out of whack? What impact does sugar consumption have on this, and how can you fix it? – Elizabeth from Brooklyn, NY

Aside from getting your fasting blood sugar tested by a doctor, or doing it yourself with blood sugar testing equipment, there are quite a few symptoms that can point to a blood sugar imbalance, such as:

  • You have insatiable sugar cravings that don’t go away even after consuming sweets.
  • When you miss a meal, you feel “hangry” (hungry and angry), lightheaded, and jittery.
  • You have trouble losing weight even though you diet and exercise.
  • You are often thirsty.
  • You pee a lot.
  • You have blurry vision.
  • You deal with brain fog on a regular basis.

There are other reasons for all these symptoms, but they are also all signs of blood sugar that is too high, or a resistance to the blood-sugar-lowering effects of insulin. When your blood sugar is elevated, your pancreas releases insulin to bring blood sugar levels back to normal. If you are consistently bombarding your body with sugar, your pancreas is constantly working to get your blood sugar back to normal. This can lead to insulin resistance and the inability for your body to use insulin properly to regulate blood sugar. If you do have unbalanced blood sugar, you can do a number of things to fix it, from supplementing with magnesium, vitamin D, and chromium to increasing your probiotic intake to reducing stress levels. For a list of my top ways to balance blood sugar, check out my article on the subject.

5. How does sugar work inside your body to contribute to acne? – Kaitlyn from Wisconsin

Oftentimes, acne is a sign of poor microbiome health. Your skin is your body’s largest organ, and in functional medicine, we see acne as an inflammatory response of the immune system, manifesting through the gut-skin axis. Sugar consumption definitely influences your microbiome in negative ways that could lead to increased acne in some people. Eating too many high-sugar foods can feed yeast and bacteria overgrowth, which can lead to candida overgrowth and contribute to chronic inflammation, and that chronic inflammation can result in inflamed skin, i.e. acne. The best way to take care of your skin is to take care of your gut by eating foods with less sugar, tons of fiber, and natural probiotics (like from fermented foods) which help bring down the overall levels of inflammation in your gut.

Photo: Stocksy


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