Sugarproof: The hidden dangers of sugar and what you can do, with author Michael Goran, PhD

Episode 69 of Ask Dr Jessica with Dr Michael Goran! Dr Goran is one of the worlds leading experts in the field of childhood obesity, and in this podcast we discuss his book “Sugarproof: The Hidden Dangers of Sugar That Are Putting Your Child’s Health at Risk and What You Can Do.” We all know sugar isn’t healthy, but the truth is it is everywhere, it’s part of our culture, and it tastes good—so what are we as parents to do?! Dr Goran’s approach is practical (he doesn’t advocate for no sugar, just less if it!) and his book provides great education and helpful tips.  

Dr Michael Goran is a Professor of Pediatrics at The Children’s Hospital of Los Angeles.  He is Program Director for Diabetes and Obesity at the Saban Research Institute.Dr. Goran also serves as Co-Director of the USC Diabetes and Obesity Research Institute. Dr. Goran is a native of Glasgow, Scotland, and received his Ph.D. from the University of Manchester, UK.Dr. Goran has published over 350 professional peer-reviewed articles and reviews. He is the Editor of the “Childhood Obesity: Causes, Consequences and Intervention Approaches” published in 2017, co-editor of “Dietary Sugars and Health” published in late 2014, and currently serves as Editor-in-Chief for Pediatric Obesity.

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.

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Transcript

Unknown: 0:00

Happy New Year and welcome to ask Dr. Jessica the podcaster My goal is to have quality conversations to help anyone out there who cares about children. I am your host and paediatrician Dr. Jessica Hochman. On today's episode, I have a very special guest, Dr. Michael Coren and Dr. Goran has spent his career dedicated to helping children live healthier lives. He is one of the world's most widely recognised experts in childhood obesity. He is a professor of Paediatrics at the University of Southern California Keck School of Medicine. And he is the co director of the USC diabetes and obesity research institute. He is very passionate about the fact that children are having more sugar than ever in their diets. So to start the new year, I thought it would be helpful and hopefully motivating to talk about this book, sugar proof, the hidden dangers of sugar that are putting your child's health at risk and what you can do. I feel lucky to welcome Dr. Goran as a guest, Dr. Goran, thank you so much for being here. My pleasure, Jessica, nice to Nice to meet you. And looking forward to talking with you. I think the topic of research that you do is probably one of the top areas of importance when it comes to children and their health. I'm so excited to talk to you about your book. So first, tell me how did you come to this area of interest? What what started it all for you? Yeah, so I, you know, I've been I've been doing research in this area for over 30 years. In the area of childhood nutrition, you know, we've seen seen a lot happening in those 30 years, obesity wasn't even talked about diabetes in children was type one diabetes, or type two diabetes in childhood was not really a thing. So we've seen a lot of changes, we've done a lot of the research. And then you know, I'm realising that what we're finding, as you said, it's so important. But people aren't reading the research. So I just, I wanted to do what I could to accelerate that translation of, of not just our research, but other research in the field. Because it's so important for for poor families today, to have that up to date information. And so the story came together, the findings came together. And it was, it was a, it was a journey to write the book, but I really wanted to get the information out to the public in an easily digestible, practical way. Early in your book, you talk about how you want to stick to data and bring about data into the conversation. Can you share with us? What is some of the data that you read? Maybe the most salient data that you found interesting, or that parents may really understand why this education is so important? I think a big big, there were several turning points. One of the big ones was I mean, it was over 10 years ago, we had a very simple question. We wanted to know what was actually what was actually in a can of soda. What is it? What it were we know it's sugar, we know it's high fructose corn syrup. But we don't, we don't really know what the chemical composition is. And so we did a very simple study. And we we just, we bought sodas from the grocery store, we bought sort of soldiers from the cinema from gas stations from a soda fountains. And we sent them off to be analysed. And I think the results were pretty surprising. We we knew that they were high in sugar, but what we found was that they were higher in a particular sugar called fructose higher than what the industry was saying was in them. And whilst at the same time, there was research going on, indicating the negative impact of fructose on growing bodies. And so I think a combination of those types of things were quite impactful. And I think also just in general, you know, everybody's an expert in nutrition these days, right? I mean, in social media, you can have a million followers and project your ideas on nutrition. But and it's called, but I wanted to make it data driven. So I'm very focused on actual studies and data and findings. And then it can be confusing. That's, that's, that's a dilemma. It's not always simple or straightforward. To have somebody to answer your question. I think it was a combination of the realisation that kids were consuming not just more sugar, but different types of sugar. And it was impacting children in different ways. And adults, because of its the way it was disrupting growth and development. And I think this is such an interesting point that you point out that sugar actually affects children more than adults. I think a lot of parents, they look at their children, as you know, they don't want to deprive them of sugar, they look at them, and they see that they're thin. When they're children, it's okay for them to have sugar. Can you explain why that isn't the case? It's, it's a dilemma for, for us in getting the message out broadly, because of this belief, I think there's a general perception that the only problem to look out for is let's see excess body weight gain. As we talked about, in the book, there's mould many, many other different impacts of sugar on growing bodies. And I think what many of those effects are, are under the skin or hidden are not all are not obvious. For example, you know, and the, the end result, it's a type two diabetes, or fatty liver disease, or even cardiovascular disease. Kids don't have those. Some of them do, unfortunately, but it's not highly prevalent. But they have the habit of silent progression. So I think it's kind of, on the one hand, the silent progression aspect, that I mean, even my daughter, my teenage daughter is always telling me, oh, this sugar is not going to kill me. So, you know, I'm up against that, in my own family, trying to kind of get the message, so I'm gonna kill you today. But, you know, over time, it will be, you know, a chronic effect, you may get diabetes 10 years earlier than other people, for example. So that's a problem. It's the kind of time horizon issue. And then I think the on the other side is the cultural thing that sugars, funds, Sweet Treats are fun. I mean, I think it's part of the fabric of, of eating and celebration. And I don't want to spoil that, for me or for anybody, because I think that is an important part of our culture, but I think it has kind of become a little out of hand. And that sugar is everywhere, there's more sugar and everything. And so we're not advocating to eliminate sugar again. The perception a lot of people have when they see me coming is like, Oh, God, hide the cookies, Michael gardens coming. But that's not what we want. We don't want to like shame people, or put sugar up on a pedestal. And so you can have it. I think it's more about moderation and learning to enjoy. And then you can enjoy cookies, with less sugar. They don't always have to be like, super sweet to enjoy them. It's those two different aspects. The silent, slow progression and the kind of perception that poets it's all or nothing. But it's not all or nothing. I like that perception that you have. Because I think that a lot of people look at sugar as an addiction. And you treat a lot of addictions by abstinence, you know. So I really think that your approach is more realistic, because as you mentioned, sugar is everywhere. And I just don't think it's, it's realistic or helpful, quite frankly, to say, never have any sugar. I don't think so. It's because if you if you say no sugar, say, Okay, I'm gonna go keto. Or if you look in a supermarket with the Keto products, I mean, keto products are just as Ultra processed as other processed foods. They're like, marketed as healthy because they're keto. But they're full of alternative synthetic or natural sweeteners. We can talk about that later. But they're still highly processed products that don't have sugar. So why do we have to make it complicated? Why can't we just use less sugar? It's a good point. Is not you know, I think that's, that's another dilemma, you know, is we forget about the simple solutions. Absolutely. It's very true. I mean, as you brought up, I think it's such an important point about all the hidden sugars that are around and I like all The tips that you offer to help parents recognise hidden sugars because that can make such a big difference. Yeah, if you know where to look, and you could recognise those hidden sugars, yes, 70% of processed foods in the supermarket contain some type of added sugar, oftentimes multiple forms of sugar, so it gets buried on the ingredient list. But if, if, if you can just kind of switch some of your products that you're buying in the grocery store, for example, things like pasta sauce, or yoghurts, peanut butters, popular items for kids, most of those types of products have sugars in them. But you can just buy a peanut butter or a pasta sauce or a yoghurt with no added sugar. And there, you can really eliminate a lot of those hidden sugars pretty quickly just by switching brands. Absolutely. I was thinking of you. Well, actually, ever since I've been reading your book I've been taking, noticing sugar more to heart. And so yesterday went and got sushi with my daughter. And I thought, Oh, this eel sauce. As you mentioned in your book, there's so much hidden sugar in the teriyaki sauce and eel sauce. So I just think you're right, educating and bringing awareness is a good, good place to start. Yeah, absolutely. And then, you know, I think we then have to deal with bringing people down from the kind of effect that were are trained into liking things are very sweet. But you can actually alter that by using less eel sauce, or, eventually, no, he also us. So that's a process, you have to go through that as a process where you do have to go without added sugars, but not for always just for let's say a week by doing the no added sugar challenge, you can teach Train the brain to have this constant preference or liking for sweeteners. So you can alter that preference down so that you can enjoy sushi with less eel sauce, or no use. We have the seven day challenge, and you do have to have everybody on board, otherwise, it's not going to work. Right? So so we can, you know, we can kind of dive into trying to understand what the barriers were. Or you can go stealth. Because you're probably or you or your husband or probably buying most of the groceries. That's true. So you can decide not to bring soda into the house or not to bring ice cream into that it's not saying you can never have ice cream again, you're gonna have it when you go out. So or you can buy different types of pasta sauce or different types of peanut butter. So that's kind of the stealth approach, which is our 28 day plan where you as the primary food buyer identify what the big culprits are. So what would you say? What are some of the top issue in your kids that you would like to change? Honestly, I think we're pretty good in our house about not having, you know, having offering plenty of fruits and vegetables and having a good, balanced diet. The biggest challenge that we face is what happens outside of this week. For example, they're having multiple holiday parties. They they do after school programmes that frequently have sugary snacks, all the birthday parties. That's the biggest challenge. Absolutely. Yeah, my daughter came home from school yesterday, offered her various things for dinner wasn't hungry, because he had, you know, various events at school for the holidays. But you know, now he's just not the time to do it anyway. So I think the time to do it is because of the holidays, the best time to do it is in the new year. So let's you know enjoy the holidays. We're not going to you know, ruin anybody's fun, but make a commitment in the new year to try and consume less sugar. I love your moderate approach. Well, you know, it just it's not going to work if you showed up with your three kids and say okay, no more. No having any more sugar or fun foods or you're going to be the kid to go to the birthday party with your own piece of cake. You know, it's just it's very it's not sustainable. And kids are likely to rebel it that against that at some point certain extent you do Just gotta hope that you keep selling that message, but not overly, at some point they will emerge from the other side and have some level of appreciation or understanding of what their mom was telling them all those years is, you know, hopefully there will be some seeds planted in their brain that will emerge later in terms of you know, when they are in college or when they're young adults. Yes, no, as you as you mentioned, in your book, I think the best thing would be as if they you educate them, and then they on their own, are motivated to, to eat healthier, just to educate parents and myself. I think reading labels is so important. And you gave so many good tips about reading labels in your book, can you explain to parents how much sugar should we tolerate when we look at labels? How many grammes of sugar is okay for our children? Yeah, great question. We have, we have a table in the book, but we can break it down to pretty simple numbers. So. And here, by the way, we're talking about added sugars, which we do now have differentiated on the food level. So added sugars are sugars that are added to food. So like, the sugar in milk doesn't count. Because that's a natural sugar in milk. We're talking about sugar that's added to peanut butter, like I mentioned, or yoghurt, so there will be a line on the nutrition label that says added sugars. That's pretty new. But we do have that now in the last couple of years. And so the guidelines are for added sugars. For the ages zero to two years of age, this is a simple recommendation. The recommendation is zero added sugars, up to two years of age. But between two and 18. It increases from zero to about 20 grammes of added sugar per day for a teenager. So depending on your age, it might be five or 10 or 15 or 20. But it's not like was I'm not like saying that. I don't think we're saying that you need to go around counting every single gramme of sugar and and logging it, I think it's what I do think it's helpful is to know what that recommendation is. Let's say your 12 year old, it's going to be let's say 15 grammes of added sugar then, then you as a parent, you have that number in your mind so that when you're at the grocery store Noops you're trying to say to which yoghurt to buy for your kid lunchbox. You have that number in mind, and then you pick one up and it's got 15 grammes of added sugar. You see, oh, that's the daily allotment. So I don't think that one's going to work. And then you might be more likely to pick something with less added sugars. It's a very hard target to meet. It's a very strict target to me, but because you can easily overcome it with one cookie or a glass of juice or glass of soda. But if you have that number in mind whilst making those key decisions, then I think you're may be more likely to choose something that's lower added sugars than higher and added sugars. And again, it doesn't have to be perfect. I'm not promoting perfectionism that you have to get to 12 grammes of added sugar, not a gramme more, not a gramme less, it's just having a general understanding of what those recommendations are, relative to what's in the foods that you buy or putting their lunchboxes or photos or snack. So So just to summarise in from the research you've done, it's the concern more as the added sugars, not sugar that's found in nature. So you're saying that dairy is okay. whole fruits are okay. But it's the added sugar that we're concerned about. Yeah, except it does get a little complicated and nuanced because fruits, you're exactly right. I don't have any problem with fruit or the sugars in dairy. Only thing is I wouldn't consume a lot of fruit all at once, but that's very uncommon. I'm talking like four or five servings of fruit all at once, four or five throughout the days. Okay. The difficulty and the complication is fruit juice. Once you take that juice out of the fruit, by government regulate Asians, technically, it's not added sugar, like the sugars in a bottle of fruit juice are not added sugar. But they're also not natural either, because you've taken the juice out of three apples and squeezed it into one bottle, right? So you've eliminated the fibre. And it's a lot more. So it's not added sugar, but the USDA doesn't count it as added sugar. But I think we should be counting that as adding sugar. Because it's not in its natural form. She's to say that eating it up, so eating an apple is okay. But drinking the juice from three apples all at once without the fibre, that's a big problem. Because nobody's eating three apples all at once, and fibres there to slow down the release of the sugars into the bloodstream. Just to help parents with label reading. Can you mention some of the added sugars that you want parents to stay away from? I know there are so many of them. But can you mention some of the big ones are pretty much all of them. Although we can talk about sugars to use in baking might be a little different. But pretty much all of the other all of the added sugars that you'll see on press pause processed foods is it is complicated. Because there's over 250 Different names that may appear on ingredient list. So food companies have gotten pretty smart about this. Because if the US 5678 different types of sugar in a, let's say an a granola bar. Like they can bury those ingredients further down on the ingredient list. So you as the consumer might not see it, because easily because it's at the bottom of the list, not at the top of the list. So thing I mean, some of my favourites are things like organic brown rice syrup, let's take that as a good example. You'll see that a lot in things like granola bars, like I mentioned are cereals. And it's, it's a great name because it's organic. It's brown, and it's rice. So it sounds pretty healthy. Right? Does but it's really, it's the same as corn syrup. It's exactly the same thing. So we all alike have have a perception of corn syrup, or organic brown rice syrup is exactly the same thing. Except it was derived from rice that was brown and organic, as opposed to from corn. So that's one here then the other one was you were seeing a lot of his concentrated fruit sugars or evaporated fruit sugars. Again, they are high in fructose and taking taken out of their natural form as in the fruit. So you know if you take a bunch of apples and juice them and then evaporate down the juice you have you know fruit sugar, which fruit sugar sounds pretty good. Doesn't it sounds quite healthy, but it's really just sugar made from fruit juice in the same way that cane sugar is sugar made from sugarcane. So it's actually worse because the fruit sugar is higher and fructose than regular sugar. regular sugar is 50% fructose, whereas fruit sugar is 70 to 75% fructose and then the high fructose corn syrup. I think that's pretty well known but that's that's so bad. It's so it's it's found in so much access in so many foods. Yeah, and I think, I don't know, I think I think a lot of parents are turned on to that now. I know to look for it, but I think that it's become easily associated with something that's not healthy. But what if I told you that regular apple juice had more fructose and high fructose corn syrup? Yeah, the most common form of high fructose corn syrup it's used in soda, for example, is about 60% fructose, but apple juice can be 70 75% So deceivingly sugary. Yeah, it's not just sugary, but it's high in fructose, it's high fructose apple juice is what it should be called. That's not to say you can enjoy apple juice, because the best solution there is just to cut it with water. Because most most of the commercial products are way too sweet anyway. So if you are drinking, if your kids are drinking apple juice, just dilute it a little bit to reduce the sugar and get your kids kind of off the sweetness preference a little bit. Two of my kids are okay with that my third and youngest, she can tell when I dilute it, and she doesn't like it. So we compromise by by giving her less. So how old are you youngest? Five, she's seven, seven. So that is on to me. Well, this is biological. So when we talk about this in the boob tube, and the food industry knows about this biology, and it's hijacking your seven year olds taste buds, because young kids have a higher preference for sweetness. They need to have something sweeter to like it. Okay, this is this is a innate preference that starts during infancy and lasts through childhood. And we don't know why. But you can imagine that it's had some type of protective mechanism, some type of protective action, from an evolutionary perspective, before we add to this overabundance of food, you know, if you if we were hunting and gathering, then this preference for sweetness would protect your seven year old from food that might have spoiled or would help them seek out something in the forest. That was sweet and healthy. So that's, that's why it's there. Food companies know about it, they make things sweeter, so that your seven year olds will like it more and get hooked on it and want it more. Even as a 12 year old as a 15 year old. This heightened preference starts to wane off later in life. So that may be why. For me as an adult and using adult, if I tasted an apple juice, I would be like, Oh my god, what is this stuff? I just don't like the taste of it. Because it's way too sweet. And I can't I can't taste the apple. I can just taste sweetness. And another topic that I think parents would love to know about the artificial sweeteners. And I know you talked a lot about this in your book, the various artificial sweeteners. What is your stance on artificial sweeteners? Is it okay for is Is it a good choice for parents to use artificial sweeteners? No. In a word, I don't think is a good idea for many reasons. I'll try to go through those reasons. First of all, is extremely limited data on the long short or long term health effects of these sweeteners in kids, whether they're synthetic, like sucralose, which is chlorinated sugar, or natural like stevia or monk fruit. Regardless of where it came from, we don't really know either affecting growing bodies. We do know from studies in children and adults that they do cause disruption in gut health, for example, they continue to do don't do don't resolve craving for sweetness and they may magnify craving for sweetness because of the way they trick the body. So something with an alternative sweetener and again, I don't care whether sucralose or stevia or monk fruit, it doesn't matter. Many people assume that if it's natural, like monkfruit, it must be okay. But the receptors in your tongue and in your brain, they don't know the difference. They get powerfully activated by these compounds. And when they get activated, the send a signal to the body to take sugar out of the blood because they think a lot of it's coming in. But it's not there to begin with. So your blood sugar goes really low and you get hypoglycemic. Which means you get cranky and hungry and end up eating more so studies in children and adults actually show that those who are obese actually consuming sweeteners ended up consuming more sugar more calories throughout the day. Because of that. I think this is great information. I know so many families that think Agave is out there that when you add agave and monkfruit, and all these quote unquote natural sweeteners that it's a good choice, I think it's important to think about what that is. And I think we forget about it, because these, these things just get normalised very quickly. Oh, Monk foods, okay. But it's not like there's bits of monk fruit in whatever the product is, the cookies or the soda, there's monkfruit tastes disgusting. As a very bad taste. There's an active ingredient in monkfruit, called Mongar. Aside A, that gets purified out of the monkfruit. In the same way that sucrose gets purified out of cane sugar, so they purify this product called longer side A, or from stevia, again, it's not like there's bits of stevia leaf. It's actually a compound called Good boy a, that gets purified. And we're so we're ingesting these compounds, with the assumption that it's not affecting the body in any way. And that's a big assumption that some of these compounds like monkfruit is not yet approved in the EU, for example, stevia I mean, there are safety levels of safety for these compounds that are really based on lab studies in rats. Based on whether or not they caused cancer in a lab rat. So that's the standard of which we're working with. It's not like anybody's tape tested these compounds to see what the 1020 30 year effect is on your child. Nobody knows what that is. So why, why would you take the chance when you can just use regular sugar, but use less of it? With for baking, for example. I mean, I, you know, you'd like to bake. My daughter likes to bake my oldest daughter, she watches the great British baking show all the time. So anyway, cool. Yeah, that's fun. Yeah. So you know, it's, it's fun, it's a great activity for kids. But most recipes, just cope with too much sugar. So you can do something against something simple. If you're baking or making something, just just add 70, you know, cut the sugar by 25 or 30%. And it's not really going to make a big impact. It might even taste better. But yeah, I think that in general, we've, the food systems become overwhelmed with all these products. That's got very complicated. Any last advice that you want? Parents to hear from you? No pressure? Well, again, I'll go back to C and L. It's just being aware of this issue and doing small things every day, or is a good place to start. It doesn't have to be perfect. It doesn't have to be all or nothing. You know, and in my personal life, I'm not a drinker. I don't really do. I don't really have many vices. But my biggest advice, anybody who knows me would agree with this is that I have a weak spot for sugar. So I really appreciated all this advice for of course, my children, but also for me, it's definitely inspiring me to take better, you know, take take, take more notice of how much sugar I'm consuming. Yeah, I would say I'm probably in the same situation as you Jessica. I don't drink. I don't even drink coffee. But I do you know, I liked like sweet treats. If it was, you know, if there were cookies downstairs or some cake that would sign that's very appealing to me versus him and say, I'm never going to eat it. You know, I'm not going to advocate for complete absence. Again. We talked about that just because I just don't think that's healthy. I think we can enjoy those parts of our of our diet. Doesn't mean to say you know, it's just all about portion size and moderation, as you mentioned. No, thank you. It's nice to hear even from the author of sugar proof that it's okay to have a little bit. Well, yeah, anything I can do Due to shake up this perception, like, like I said earlier, like, people like see me coming in, they think I'm the sugar police because I wrote the book. But again, it's it's part of our culture is part of our celebration has just gotten out of hand a little bit and absolutely has multiple effects on on kids bodies. I think the work you're doing, again is so important because as you mentioned, it is such a part of our culture and it's really harmful for children in their and their house in a big way. Yeah, well thank you for all you're doing to kind of bring bring that information to the public. Thank you so much for listening to this week's episode of Ask Dr. Jessica. I hope you learned a lot from Dr. Michael Goran. I know I definitely did. Also I would be so appreciative if you could do two things for me. First, please, if you could be so kind as to leave a review wherever it is you listen to podcasts. And second, please pass this episode along to anyone who you think may like it. See you next Monday.