Peter Attia, MD in his article on his blog asks the question “Is sugar toxic?”. Within the article Dr. Attia discusses his belief that while sugar may not be an acute toxin, sugar is a long-term chronic toxin that will slowly kill us. He suggests that what determines how quickly it kills us are the variations in our tolerance levels. I’m going to suggest that in addition to our (movable internal and external) tolerance levels is our ability to recover and buffer these responses. That these responses vary (not just when but how) and response levels can be altered early in life or regularly during our lives. I’m going to discuss toxicity in the context of synergy, chaos dynamics, hormesis and stress balancing.
I agree with what Peter Attia, Mark Bittman, Robert Lustig and Gary Taubes are trying to do when they are warning the public that added sugars and processed foods are toxic to us. It’s a true and necessary point of view for many reasons. Not just that it is defeating the prevailing framework of “fat is the culprit” or that “it’s really all about calories”, but also because I think sugar as a culprit, or at least its elimination as a solution, works especially well for those on that side of the spectrum (I refer to them as my East Coast peeps). Of course these guys know there is a distribution involved here, but they aren’t sure why (I have a few theories), and they may not realize that they are referring to about 30% of the population (to a lesser degree to may be another 20-30%, so 50-60% total). Ketogenic, paleo or low carb diets, either intermittently or as a lifestyle, are effective and proper routes to solutions for these individuals on that side of the distribution curve. They are essentially turning their “toxic food” environment, and their reactions to it, around by getting rid of sugars and lowering carbohydrates, which we should all do to some extent, but for them especially.
So then the question remains that if the sugar-elimination solution is only ideal for 30% of the population (<10% at any given time), then what about solutions or preventions for metabolic syndrome for the other 70%? How might moving from a “toxin” language to a “stress” language be better suited to finding more complete solutions for everyone?
A toxin: Can kill us quickly or slowly and must be processed out of body mainly by liver and other organs. Chronic exposure signifies that the substance builds up in the system or organ degradation to reach tipping points.
A stress (oxidative or allostatic): Can kill us slowly with unremitting and unmanaged demands. The stressor itself can damage cells much like a toxin, but our bodies own attempts to protect us with the trade-offs and compensations can be inefficient and eventually debilitating.
(Other ways to measure forms or levels of toxicity other than the liver is through inflammatory pathways (TLR4) and oxidative stress. It is the excess of stress, or too much work to do, that makes a toxin toxic.)
Why is a stress perspective important? There are two schools of thought in toxicology. First is “the dose makes the poison“. It is the most commonly known and generally accepted concept that the amount of acute exposure determines whether or not it is toxic to the system. Typically this is a consequence of liver processing ability, but it can also be the central nervous system or direct damage to organs by the toxin. Toxins aren’t typically thought of as having anything inherently good about them. In stress dynamics there is another school of thought on toxicology and this includes dynamics of toxins being dependent on the system and that system’s chosen strategyto recover from the assault or potential assault of the toxins. Which means it is much more than just a point in a line or the dose creating the toxic effect, from that counter-perspective, it is the system itself creating the outcome.
This allows for not only different levels but different than expected actions of toxins. Like a less amount of toxin can be more toxic to the system than a greater amount. The same toxin can also have different impacts depending on timing, resources and strategies of the system it is put into. The same toxin can create different outcomes. The stress dynamics of toxins can also have hormetic responses. Which is at one level a toxin having a negative impact can also be having a positive impact somewhere else. This is of course complicated because just because it has a “positive” doesn’t make it ‘good’, toxins are still bad. However, if we think of exercise as a “stress with benefits”, the potential for damage through exertion creates adaptations that are general improvements to the resiliency of the system, too much and exercise becomes toxic damage (excessive, unremitted and unrecovered). So that type of challenge, even when it causes or threatens damage, is excellent for the system. It challenges it to be stronger.
A stress dynamic also means good things that bring us benefits can also create stress and either inherently be toxic along with or get to a level of being toxic. If that toxicity is abated (with recovery) then it doesn’t utlimately impact the system. If it isn’t abated in a timely fashion then it can potentially wear the system down. Beneficial substances have trade-offs or costs in stress dynamics. They can be good and bad at the same time. Food doesn’t come for free.
Most experts are in the language that we “eat too much” sugar. Which is true and there is nothing wrong with the truth of that statement except that it is a direct and linear statement. Without the discussion of the context both synergistically with the other constituents of the diet and the action of the system it lacks truth and would be an incomplete solution.
Are protein and fats “toxic” as well?
Foods are stressful to the system as they take time, energy and resources to break down and clean up. The macronutrients of sugars, proteins and fats tend to be stressful and all three can create toxicity in their own ways. Sugar (fructose) can overwhelm the liver. Protein can also overwhelm and produce toxic wastes. And fats can overwhelm our oxidative capacities via the liver, spleen, mitochondria, Nrf2, and others (fat is a very influential substance!). This impact can be synergistically increased depending on context. The whole is more than the sum of its parts. Different types of food sources, like high fat and high cholesterol or high fat and high sugar have their effects multiplied beyond what we could expect by adding them together or looking at them separately (this hints of a manifold, a need to switch to new scientific modeling, just because separately we find things true doesn’t mean in the whole they will be true). Stress doesn’t find a single blame but takes into account the interactive mechanisms and ways they play into and off each other. There is no singular blame in stress dynamics, but we can certainly blame these things that drag our systems down and we can find patterns as to whom might be most susceptible, or find unique compensation patterns within subpopulations with dynamic outcomes to the stress.
Chronic toxic exposure (like to pesticides) makes sugar (our processing of it) more stressful. Chronic sugar exposure can also make pesticides more toxic (bidirectional and interactive causation). Stress make stresses more stressful. Long-term chronic toxic exposure to pesticides may create a situation for some to be less tolerant to stress, sugar and more susceptible to obesity-related conditions. Of course the vice-versa is also true. That our long-term exposure to High Fructose Corn Syrup (HFCS) can contribute to these disorders and make us more susceptible to toxins like pesticides.
And we can’t blame fructose “and all sugar as the same”, because fructose in honey is quite different than fructose in HFCS. According to researchers “in terms of toxicological capacity, a diet of sugar is not equivalent to a diet of honey” when it comes to the bees capacity to handle stress (Johnson 2012). You could say this doesn’t transpose to humans, but we know that HFCS can induce diabesity, whereas honey has anti-diabetic properties. All sugar sources are not equal, except when you want to eliminate it from the diet to get a ketogenic influence.
“If you’re feeding them (bees) high-fructose corn syrup, then pathogens may be more dangerous and pesticides can be more toxic,” said May Berenbaum, an entomologist at the University of Illinois-Urbana/Champaign, the lead author of the study. (LA Times)
Are Junk foods “nutritionally negative”?
This is why I prefer calling added sugars stressors and processed foods “nutritionally negative”. They can impact the system in some incredibly negative ways, and in that way it most certainly can be considered toxic.
Sugars in isolated forms and isolated from natural foods are “toxic” because they become a stress we can’t manage. They come without resources we need to manage the stress they cause. How well we handle carbohydrates depends on not only the system it is put into, but the context it comes in. Stress would be ok, but not unremitted and not without ways to recover from it. Processed foods and combinations of sugar-fat (msg and salt) are certainly, and provably toxic to the system. How long we can handle it depends on what kind of trade-offs we (our bodies) are willing and able to make.
One example in this stress-signalling is the Nrf2 pathway (others include mTOR, AMPK, Sirtuin systems), one of our master stress regulators. Nrf2 is an oxidant system which can protect us from or create (amplify) diseases. Stress isn’t about getting rid of stress, it’s about balancing stress with resources and getting accurate information about what we can and can not handle. Fructose, fat, especially high of both can tweak this pathway. What is in our diet signals to this system the nature of our environment and it responds by altering our responses to stress (and debilitating us in the process if stressors/resources are out of whack). Food manipulation techniques like fasting, ketosis or even exercise (it creates a stress that influences the adaptation) can potentially re-regulate this regulator pathway and help us out. It’s essentially telling the body what kind of resources we have and it resets its strategy in accordance to what we are subjecting it to.
For Peter Attia and others, sugar has become toxic because they can not pay that tax for making any forms of sugar useful. Their current strategy doesn’t allow for sugar sources to be seen as friendly, so sugars are toxic to them in any form, an extreme version on a distribution. That may have been partly genetic (neuroendocrine-ly biological?) or it may have been influenced adaptively early in their (stress->information) exposures like pesticides or mother/father’s diet which creates what is called an epigenetic change in their tolerance and reaction to stressors.
It depends on the system it goes into and what that system is doing.
A “fat only” diet changes the communication and activity of the system and the relationship and reaction the fat has with the body. It’s not just that the carbs are missing, but how those missing carbohydrates alter the action of the system. It’s the system that matters, not just “how much” of something is present or absent. (you can see my post “Do you need fruits and vegetables on a ketogenic diet?”
As Richard Feinman in “When is a High fat diet not a High fat diet” states:
In explaining the importance of macronutrient composition to students … we stress the need to get away from the principle that “you are what you eat,” and replace it with the idea that “you are what you do with what you eat.”
Peter Attia on a virtually “no sugar” diet has his internal mechanisms to attenuate stress. Robert Lustig insists that orange juice is a bad sugar. However, the phytonutrients in fresh juices offer benefits as orange juice helps to attenuate the stress of a high fat, high carb meal, like bacon, eggs and toast. This is of course if you are not eating to lose weight and have proper insulin responses. Peter being in a state of stress resiliency (ketosis), may do fine without the orange juice to attenuate his stress from the meal. However, someone on a more moderate diet may benefit from that orange juice with his bacon, eggs and toast.
I’m with Peter and would be happy to have High Fructose Corn syrup labeled as a Toxic substance. I would also encourage table sugar to be used sparingly and have us revert to the quantities and natural states of sugars (molasses, honey, etc) in whole food recipes. And at the very least our refined carbohydrates (pasta, rice) and tubers to stay in the context of a meal that includes other nutrient-dense whole food sources like quality fats, protein, veggies, herbs, spices and sauces to make them better energy resources as we keep the stress in balance.
Conclusions: Changing from “Is sugar toxic” to “When is sugar toxic”.
So the important question isn’t “Is sugar toxic?” but rather when and why is sugar toxic? And the absolute crucial question is how is it that sugar is becoming more toxic to us? Partly because of their isolated unnatural overly processed forms and partly because of our responses to them as we have had an increase in stressors (other toxins and loss of resources). This is why sugar doesn’t cause obesity any more than calories cause obesity, and why sugar does cause obesity as much as calories do. Just not directly or singularly, it occurs more because of the communication these stresses create and the inadequate compensations of the system. The cause of obesity and chronic disorders is our inability to handle stress, which excessive fat, calories and sugar create, along with other factors of stress resililency being compromised and ‘tweaked’ by environmental exposures. Obesity and metabolic syndromes are our subsequent failing attempts to manage the stress.
Stress seems to be a better framework than toxicity, as toxicity is a concept of damage. If obesity and chronic disorders were damage then it would be a disease, a damaged state, which is true to a point. But the whole story of obesity is more complicated than that (Peter discusses this in “Is the “obesity crisis” a symptom of a deeper problem“) . Obesity and chronic disorders aren’t operating solely because of damage but rather on the more subtle levels of attempts to prevent damage (which then creates damaged and damaging states unfortunately). But it is the stress mechanisms that create adaptations and then the subsequent symptoms we see. In that way, from a stress perspective, obesity is seen first an attempt to find calories (resources for stress) and store fat (since there is a greater demand for resources). And then downregulations because of that continued unresolved stress (from junk foods) and finally into disease states. It’s not a straight line like the language of toxicity suggests, but a system desperately trying to regulate itself within the environment it is in. That is the language of stress.
Not just what to exclude but what to include
Peter’s hypothesis is that the problem is too much glucose. I would say the problem is too much stress (and a scientific framework that was built to ignore stress dynamics). But the greatest thing about stress dynamics is it tells us what to include in our diets, not just what to exclude (lower sugar), and that is the dynamic power of culinary meals and whole foods. So we can avoid “junk foods” because they are really just imitations of our “comfort foods” which we need when we are under stress. So we have to replace the fake stuff with real stuff and find our own natural flows and rhythms. (This of course may be after a spell of “retraining” the system or other system considerations, some will respond better to particular dietary strategies to regain health).
Problem-solving this issues with stress dynamics in mind, like systems thinking and epigenetics tells us not only what not to eat (processed foods) but other aspects to re-regulate and prevent stress. Which is including family, social relationships, community, exercise, sports, intellectual challenges, fun in the sun, purpose, cleaning up our environment and of course delicious meals all working together to create balance.
- Gary Taubes: “Is sugar toxic?” New York Times 2011
- Association for Psychological Science (2011, September 11). Sick body, vigilant mind. ScienceDaily. Retrieved June 8, 2013, from http://www.sciencedaily.com/releases/2011/09/110908170057.htm
- Gender-specific reduction of hepatic Mrp2 expression by high-fat diet protects female mice from ANIT toxicity. Kong B, Csanaky IL, Aleksunes LM, Patni M, Chen Q, Ma X, Jaeschke H, Weir S, Broward M, Klaassen CD, Guo GL. Toxicol Appl Pharmacol. 2012 Jun 1;261(2):189-95. doi: 10.1016/j.taap.2012.04.001. Epub 2012 Apr 11. http://www.ncbi.nlm.nih.gov/pubmed/22521610
- Hydrochlorothiazide and high-fat diets reduce plasma magnesium levels and increase hepatic oxidative stress in rats. Ribeiro MC, Avila DS, Barbosa NB, Meinerz DF, Waczuk EP, Hassan W, Rocha JB.Magnes Res. 2013 Feb 1;26(1):32-40. doi: 10.1684/mrh.2013.0334. http://www.ncbi.nlm.nih.gov/pubmed/23657239
- Cocaine toxicity and hepatic oxidative stress. Vitcheva V.Curr Med Chem. 2012;19(33):5677-82. http://www.ncbi.nlm.nih.gov/pubmed/22856658
- Biochemical and Cellular Mechanisms of Toxic Liver Injury. Neil Kaplowitz, M.D. Seminars in Liver Disease. http://www.medscape.com/viewarticle/433631_6
- The Dose Makes the Poison—Or Does It? http://www.actionbioscience.org/environment/trautmann.html
- Hormesis Defined. Mark P. Mattson. Ageing Res Rev. 2008 January; 7(1): 1–7. doi: 10.1016/j.arr.2007.08.007 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2248601/
- Sugar and Fat Bingeing Have Notable Differences in Addictive-like Behavior. http://jn.nutrition.org/content/139/3/623.full
- A review of issues of dietary protein intake in humans. Bilsborough S, Mann N. Int J Sport Nutr Exerc Metab. 2006 Apr;16(2):129-52. http://www.ncbi.nlm.nih.gov/pubmed/16779921
- Q&A: ‘Toxic’ effects of sugar: should we be afraid of fructose?Luc Tappy. BMC Biol. 2012; 10: 42. doi: 10.1186/1741-7007-10-42. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3357317/
- Benefits of Fructose by CO2 Factor Blog. http://co2factor.blogspot.com/2012/04/benefits-of-fructose.html
- Melatonin may curtail the metabolic syndrome: studies on initial and fully established fructose-induced metabolic syndrome in rats. Cardinali DP, Bernasconi PA, Reynoso R, Toso CF, Scacchi P. Int J Mol Sci. 2013 Jan 25;14(2):2502-14. doi: 10.3390/ijms14022502. http://www.ncbi.nlm.nih.gov/pubmed/23354480
- Lipoic acid attenuates high-fat-diet-induced oxidative stress and B-cell-related immune depression. Cui J, Xiao Y, Shi YH, Wang B, Le GW. Nutrition. 2012 Mar;28(3):275-80. doi: 10.1016/j.nut.2011.10.016.
- Curcumin decreases oxidative stress in mitochondria isolated from liver and kidneys of high-fat diet-induced obese mice. Martínez-Morúa A, Soto-Urquieta MG, Franco-Robles E. J Asian Nat Prod Res. 2013 Jun 19.http://www.ncbi.nlm.nih.gov/pubmed/23782307
- Metabolic and behavioural effects of sucrose and fructose/glucose drinks in the rat. Sheludiakova A, Rooney K, Boakes RA. Eur J Nutr. 2012 Jun;51(4):445-54. doi: 10.1007/s00394-011-0228-x. Epub 2011 Jul 29. http://www.ncbi.nlm.nih.gov/pubmed/21800086
- Ellagic acid attenuates high-carbohydrate, high-fat diet-induced metabolic syndrome in rats. Panchal SK, Ward L, Brown L. Eur J Nutr. 2013 Mar;52(2):559-68. doi: 10.1007/s00394-012-0358-9. Epub 2012 Apr 27. http://www.ncbi.nlm.nih.gov/pubmed/22538930
- High-fructose, medium chain trans fat diet induces liver fibrosis and elevates plasma coenzyme Q9 in a novel murine model of obesity and nonalcoholic steatohepatitis. Kohli R, Kirby M, Xanthakos SA, Softic S,Hepatology. 2010 Sep;52(3):934-44. doi: 10.1002/hep.23797. http://www.ncbi.nlm.nih.gov/pubmed/20607689