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145: How to Sugarproof your kids with Dr. Michael Goran
3rd October 2021 • Your Parenting Mojo - Respectful, research-based parenting ideas to help kids thrive • Jen Lumanlan
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  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).

  [accordion] [accordion-item title="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...

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