Medically reviewed by Dr. Stacy Hengisman MD and Felice Ramallo MSRD.
It almost goes without saying that sugar is one of the most demonized nutrients on the supermarket aisle right now. For many of us, we have a love-hate relationship with sugar: we frequently add it to foods and enjoy the taste it brings, but we know an overindulgence can lead to undesirable long-term health implications, such as insulin resistance (IR) and type 2 diabetes. This conflict can be especially true for those with metabolic or hormonal health conditions. Many experts believe sugar plays a role in undesired or unintentional weight gain, which may lead to problems like “impairments in hormone signaling.” But should we demonize sugar? Afterall, insulin resistance is a risk of consuming too much sugar, but it’s not a guarantee of consuming any sugar. Is it possible to enjoy sugar in moderation? What exactly, biologically speaking, happens when we consume sugar? And if we want to, how can we cut down on sugar in our diet? We will answer all of these questions, as well as discuss the impact sugar has on our hormones, so we can make better informed choices surrounding how much sugar to add to our diet.
The science behind insulin explained
Insulin is a hormone that nearly every body produces. As we reach mealtime, smell or taste food, and eventually ingest and absorb our food’s nutrients, the body responds with the increasing release of insulin. Insulin works by helping glucose in your blood enter muscle, fat and liver cells so that these cells can use it for energy or store it for later use. All foods eventually break down to glucose, no matter if they’re made of carbohydrate, fat, protein, or alcohol.
How does insulin resistance happen?
The exact cause of insulin resistance is not known, but it’s a complex condition in which your body does not respond as it should to insulin. Insulin resistance may occur over time. The most common way that it develops is by eating quantities or types of foods that cause rapid changes in blood glucose, like easily-digestible carbohydrates on their own, and when they aren’t needed. For example, if one were to eat a large quantity of sweets without fiber, protein foods, or a source of fats, it would quickly be absorbed into the bloodstream. When that happens, the body pumps out plenty of insulin to get the glucose into the cells and out of the bloodstream as quickly as possible. Because cells are so sensitive to the hormone, if they are regularly inundated by it, they start to ignore whatever the message is. However, if there is a lower intensity message that happens predictably throughout the day, the cells respond much more appropriately, and can take in sugar at a healthy pace that they won’t become desensitized to. That is where discussion about smaller, frequent meals, incorporating protein or fat, and glycemic index or load comes in; as these are all players in maintaining healthy blood sugars and responses to insulin.
Maintaining Healthy Blood Sugar
Preventing insulin resistance goes hand-in-hand with maintaining healthy blood sugars in the long run. There are a handful of effective strategies that can be used together in this pursuit. At minimum, one’s diet should include ample sources of protein, fat, and carbohydrate (the macronutrients) at all meals or snacks. As the body digests food, everything gets mixed around and partially broken down in the stomach before being passed along to the intestine for the absorption of nutrients. When foods that contain the macronutrients combine, they create a slurry that takes more time to absorb. When fiber is added to that mix, the food takes even longer to absorb, partly because our gut bacteria has to break down the fiber and other components more before our bodies can accept the nutrients. Instead of stand-alone refined carbohydrates (low in fiber) that can be immediately taken in by the first sections of the intestine, alternatively, the diverse food mass has more nutrients to unlock and deconstruct before being accepted into the bloodstream. That extra digestion time means that blood sugar spikes are lower, longer, and more sustained – something that very directly translates to energy levels throughout the day.
Glycemic Index and Load
Fiber is also involved in the glycemic index and load of food items. Glycemic Index (GI) is a scale of 0 to 100 measuring how much a food would increase one’s blood sugar, with pure glucose (sugar) being 100. Glycemic Load (GL) adds nuance to GI by considering serving size of the food, which matters in a few instances where a food’s glycemic index may be high, however, per the serving size, it doesn’t raise blood sugar to the same extent. For foods like fruits, GI may be high, but GL is low, indicating it would be a good choice to prevent blood sugar swings. Foods with a lower GI or GL are typically higher in fiber and lower in sugar or more easily digestible carbohydrates. For the most part, GI or GL can be used interchangeably for guiding food choices. A goal for many people looking to keep blood sugar levels from spiking and crashing should be to choose lower GI or GL foods whenever possible which would be items with GI or GL labeled at 45 or less, to reduce long-term risk of weight gain and type 2 diabetes. When it comes to grains, that means picking more ancient grains, whole grains, or sourdoughs. A more exhaustive list of food comparisons can be found in our education material “Glycemic Index Swaps.” Those swaps would support a more stable blood sugar throughout the day, prevent the development of insulin resistance, and improve other symptoms. If you are combining any food with protein, fat, or fiber; you are lowering the glycemic load of a meal. This brings us to the next point: meal patterns.
Another strategy that may prevent or improve insulin resistance is eating more frequently throughout the day. Research shows that eating more frequently than the ‘3 meals per day’ standard improves markers of insulin resistance and tests of insulin sensitivity. Significant improvements were seen in individuals who consumed 6 small meals per day. We can think of these smaller meals or snacks as smaller ‘doses’ of nutrients into the bloodstream at any given time, keeping blood glucose (BG) more stable. The more drastic blood sugar swings are, such as in the case of larger, more frequent meals, the more difficult it is for the body to produce the appropriate amount of insulin. Over time, that can be another contributor to insulin resistance.Small, frequent meals keep BG levels stable, therefore it won’t drop to a level that may trigger a sugar craving, one of the body’s mechanisms for regulating our BGs when it falls too low.
Sugar and carbohydrate cravings are complex psychological and physiological cues that tell us, ‘I need sugar, and I need it now’ - they can be caused by emotional, environmental, or even physical triggers.
What to do when a craving hits
Sugar cravings are powerful; if you have resolved to reduce your sugar cravings and you have a desire for a chocolate bar, for instance, know that this isn’t a sign of a ‘lack of discipline.’ And if you do decide to honor your craving, please try not to lambast yourself with criticisms - this can lead to a binge/restrict mindset in which you are having a ‘good’ day when you have zero sugar and your whole day is shot when you consume ‘too much’ sugar. This black and white mindset isn’t healthy, and it isn’t productive - in fact, it’s harmful.
The first thing to do is to properly nourish yourself. If you want a sweet, have it. If there is a lower sugar option that will satisfy you, even better. However, we often want the real thing, and that’s normal and okay. We recommend pairing the sweet with fiber, protein and fat, to lower the blood sugar change. Think about following the Allara Dessert Plate.
Once you’ve had your sweet, do you best to figure out what’s caused it. The most common culprits are A) not getting enough energy or carbohydrates throughout the day, or B) not adding components like protein, fiber, or fat for balance when eating.With this in mind, here are a couple of things to try if you don’t want to eat a sweet:
- Start with an otherwise balanced snack or meal
- Sometimes cravings are more of an indicator of extreme hunger. If you haven’t eaten in a while, try nourishing your body with a balanced meal or snack, and see if that’s what you really needed. If you’re still craving carbs, go on and have it!
- Go do something else for 10 minutes
- Set a 10 minute timer and go do something else - maybe go for a walk, call a friend, or pick up a book. If your craving has passed by the time the timer has gone off, then move on with your day. If not, then go eat your snack.
Oftentimes, eating sugary foods feels good and almost therapeutic, especially if you have had a hard day. Especially if this is a habit or coping mechanism you’ve built up, it can be hard to break out of the cycle. Craving your favorite comfort foods doesn’t make you weak-willed or a bad person - try to ask yourself where the craving is coming from: is it environmental? Physical? Did something happen that prompted you? Recognize that habits take time to change, and approach your cravings from a place of curiosity and reflection rather than judgment.
Sugar and Sweeteners
Now for some myth busting and clarification! Excess sugar intake is in fact a contributor to insulin resistance and overall inflammation throughout the body. That doesn’t mean that it is bad, immoral, or “hiding” in foods. As mentioned in the section about GI/GL, more important than avoiding sugar at all costs is choosing lower glycemic foods and balanced meals. Because most foods don’t have their glycemic information printed on the label, another strategy to reduce excess sugar consumption is to generally keep tabs on the amount of added sugars consumed per day.
Natural and Added Sugars
Naturally occurring sugar is the sugar content before other sweeteners are added. Added sugars can be any nutritive sweetener (meaning providing energy/macronutrients) or sweetening agent that is incorporated into a product or recipe. Added sugars could include agave syrup, maple syrup, honey, fruit preserves, or any other ‘sweet’ ingredient. When considering options to buy, or guiding portion sizes, one should aim to stay below 50g of added sugar per day (per USDA guidelines). This is a separate line item than total sugars. ‘Added sugars’ are broken out on their own, below total sugars, on the nutrition label. It can be easier to keep track of by simply shopping for foods with a single serving of 10g added sugars or less, and as close to 0g as possible in foods that you don’t need to taste sweet. This will make it harder for them to add up throughout the day, and allows you to ignore the nutrition label throughout the day.
This 50g amount is what is indicated to ensure you are eating nutrient-dense foods and preventing risk of chronic diseases (i.e. insulin resistance and type 2 diabetes). Also of note, our bodies do not discern between added or naturally occuring sugars in food. To keep sugar intake in check, the most effective method is consuming a variety of whole foods from each food group, and aiming to stay below 50g (based on 2000 kcal per day diet; 10% of daily calories) from added sugars.
Types of Sweeteners
A common suggestion for combating insulin resistance or reducing sugar intake is to use non-nutritive sweeteners (NNS), often called artificial sweeteners, in place of nutritive sweeteners like sugar. These include products like stevia, monk fruit, aspartame, and sucralose (Splenda). The names nutritive and non-nutritive come from whether or not the sweetener contributes significant energy (calories) or sugar to the diet. It is important to note that there are few indicators that NNS help general health or insulin resistance in any significant way. In fact, evidence suggests that they may be doing the opposite and damaging our health.
Importantly, NNS sweeteners are absolutely safe in small and infrequent amounts, just like sugar or other nutritive sweeteners. However it’s important to note that a recent analysis of the research landscape has shown inconclusive results surrounding whether they have positive or negative impacts on things like dental health, preterm labor, gut health, risk of preterm labor, weight gain, diabetes, kidney disease, and even hypertension.
As a result, both sugars and NNS may have health downsides. While more research is being conducted on NSS and their long-term health implications, in general, we would recommend going with the “real sugar” and using strategies to reduce the impact on blood glucose rise, such as:
- Making sweetened items at home, where you can use the minimum amount of sweetness to get the flavor outcome you’re looking for
- Using lower glycemic index sweeteners like maple syrup, honey, agave, or coconut sugar
- Pairing sweets following the Allara Dessert Plate (pictured above)
In other cases, it can make sense to choose the NNS to keep blood sugar more stable. The more insulin resistant or diabetic someone is, the more they may want to choose NNS. Additionally, in drinks where there is a lot of sweetness added and nothing else (i.e. sodas, iced teas, lemonades, etc.), it can be hard to keep blood sugar stable, and it might make sense to choose a “diet” or NNS option.
Sugar and our hormones
Having sugar, either in the form of the odd cookie or occasional candy, isn’t associated with hormonal havoc in and of itself. However, a high sugar diet can lead to not just insulin resistance, but metabolic syndrome: a group of conditions that raise risk of coronary heart disease, diabetes, stroke, and other serious health problems. One of the diagnosing criteria for metabolic syndrome can be obesity. IThe more we are learning about the relationship between weight and health, the more we are learning that BMI may not be the most reliable metric; however, having a higher BMI can make it more likely that your body’s adipose tissue (fat tissue) is engaged in cell signaling that can make it harder for our body to respond to blood sugar changes appropriately.
There is evidence to suggest that metabolic syndrome, and one of its symptoms, obesity or excess weight gain, can be associated with several “endocrine alterations” which can include hypothyroidism, Cushing’s disease, and growth hormone deficiency. Unintentional weight gain is also seen as a side effect of PCOS, a reproductive health condition that is characterized by excess androgens and often insulin resistance. In one animal study, “a high-fat, high sugar diet led to disrupted preovulatory and basal hormone levels and induced cystic ovaries in a rodent model of induced obesity.” The same study also points out other studies which “suggested that impairments in hormone signaling are associated with the development of acyclicity and ovarian cysts” but that these same studies haven’t been able to explain how these hormonal changes arise, and “how they might contribute to the progression of reproductive diseases.”
Perhaps Medical News Today put it best when explaining the association between excessive sugar intake, such as in sugar sweetened beverages, and type 2 diabetes: “it is not true that sugar causes diabetes. A high calorie diet of any kind can lead to type 2 diabetes. However, in most cases, diets high in sugar are high in calories. This can increase the risk of diabetes.”
The same could be said for sugar and hormonal or many other health conditions: consuming sugar now and again in moderation is not likely to throw your hormones off balance, but consuming sugar in excess is associated with higher rates of inflammation and disease pathogenesis, which basically means that other conditions can be exacerbated by regular blood sugar roller coasters. That includes conditions like thyroid disease, endometriosis, and even perimenopause and menopause. Of course, excessive sugar intake has its own long-term health implications, such as type 2 diabetes, and various metabolic and hormonal disorders.
Key take-aways on sugar:
Sweets are “fun foods” and have a place in a nourishing and balanced diet, just like anything else. They are associated with birthdays, family outings, or parties with friends. They are the 5-10 extra pounds that stick around when you have a happy and fulfilling social and personal life, and definitely nothing to be concerned or critical of. When you’re 80 years old and reminiscing, you’ll thank me for this encouragement. Additionally, artificial sweeteners may be damaging to your health, and there is no good indication to use them. Instead, when grocery shopping, use nutrition labels to make choices that help you stay beneath the goal of 50g added sugars per day. Aim for a variety of food groups at all meals, and choose lower glycemic foods when possible (refer to “Glycemic Index Swaps” handout as needed). Honor your cravings, but find compassionate and healthy ways to prevent them. There is never a necessity for militant restriction. Our bodies tell us so much about our needs, so trust them, honor them, and love them.
If you’re looking for additional help navigating your nutritional needs when it comes to addressing hormonal imbalances, our Registered Dietitians at Allara can help you develop a personalized nutrition plan that meets your goals.