We all know that excess sugar in our diet can lead to diabetes and weight gain. But did you ever stop to think about how sugar affects your brain? If you’re thinking “I switched to artificial sweeteners, so I'm O.K.,” listen up: they come with their own set of impacts on your brain chemistry.
Join host, Jonathan Fialkow, M.D., and his guest Dalia Lorenzo, M.D., a neurologist at Miami Neuroscience Institute, for important insights into the effects of sweeteners on mood, memory and even Alzheimer's Disease.
(For more on diet and brain health, Dr. Lorenzo recommends this video:
Power Foods for the Brain - Dr. Neal Barnard)
We all know that excess sugar in our diet can lead to diabetes and weight gain. But did you ever stop to think about how sugar affects your brain? If you’re thinking “I switched to artificial sweeteners, so I'm O.K.,” listen up: they come with their own set of impacts on your brain chemistry.
Join host, Jonathan Fialkow, M.D., and his guest Dalia Lorenzo, M.D., a neurologist at Miami Neuroscience Institute, for important insights into the effects of sweeteners on mood, memory and even Alzheimer's Disease.
(For more on diet and brain health, Dr. Lorenzo recommends this video:
Power Foods for the Brain - Dr. Neal Barnard)
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Dr. Jonathan Fialkow:
Welcome, Baptist Health Talk podcast listeners. I'm your host, Dr. Jonathan Fialkow. I'm a preventative cardiologist and lipidologist at Baptist Health's Miami Cardiac and Vascular Institute, where I'm also chief of cardiology at Baptist Hospital and chief, population health officer at Baptist Health. When we think about the amount of sugar we consume, we're probably focusing on its impact on our waistlines, or its connection to diabetes and other chronic conditions, like heart disease and cancer, all of which are very important.
Dr. Jonathan Fialkow:
But did you ever stop to think of how sugar affects our brains? If you're thinking, "I switched to artificial sweeteners so that doesn't apply to me," well, listen up. Even without calories, artificial sweeteners pack a powerful punch to the brain. We're going to look at the many ways sugar and sweeteners affect our brain health in today's episode. My guest is Dr. Dalia Lorenzo, a neurologist at the Miami Neuroscience Institute, part of Baptist Health South Florida. It's a fascinating subject and something we should all be much more aware of. Welcome to the podcast, Dalia.
Dr. Dalia Lorenzo:
Thank you.
Dr. Jonathan Fialkow:
Let's start with sugar in general. Obviously sugar is table sugar, which is what we generally think of as the sweet stuff we use to cook and add, but there's lots of forms of sugar. Our brains do need some sugar in the form of glucose as a fuel function. Can you talk about how the brain uses glucose?
Dr. Dalia Lorenzo:
That's actually very important because the brain only uses glucose as a fuel supply, as opposed to some of the other organs. So for example, muscle, a muscle can use glucose, but then when it runs out, it has some reserves in the form of the glycogen and fat, but in the brain, the situation is different. In the brain, the brain doesn't have any stores or reserves of energy, and it really depends minute to minute for on the glucose that is provided through the circulation. So it's minute to minute. And if you really think about it, the brain per weight uses a lot more fuel source, the glucose fuel source, than any other organ in the body.
Dr. Jonathan Fialkow:
Now, of course, we're talking about glucose in the blood, not necessarily in the diet, but if the brain doesn't get enough glucose, if our blood glucose drops, what are the effects of the brain?
Dr. Dalia Lorenzo:
Well, as you can imagine, without the fuel, the nerve cells are not going to function well. And so you'll start to see some problems with performance, both with ... some people it'll be hard for them to think. They can't concentrate. Many times they can actually start to show symptoms as if they were having a stroke. They can get confused, and if it gets very, very low, then it can do damage. There can be actual damage done to the nerve cells.
Dr. Jonathan Fialkow:
We generally see that in hypoglycemia-
Dr. Dalia Lorenzo:
Correct.
Dr. Jonathan Fialkow:
... when usually patients are over-medicated with insulin and things, the neurological effects is generally how you know something's going on.
Dr. Dalia Lorenzo:
Right, to the point where they can even have seizures. When the glucose drops low enough, it can lower the seizure threshold and provoke seizures. Yeah.
Dr. Jonathan Fialkow:
Now, is there any risk from too high a sugar? So, if the blood sugar is very elevated, does that affect the brain?
Dr. Dalia Lorenzo:
Yeah, definitely, you can, on the other end of the spectrum as well. First of all, you can see a lot of mood changes when the glucose gets too high. People get irritable. Many times they just can't concentrate well, they can't think rapidly. They've actually done studies where they show that ... just can't think as rapidly.
Dr. Jonathan Fialkow:
So, our bodies do maintain a physiological range of sugar in the blood, not too low, so the brain gets the energy it needs, not too high, so the brain and organs have the problems that you just described. And of course, there are medical conditions that can affect that either way.
Dr. Jonathan Fialkow:
Getting back to the diet now, we talk about table sugar. Again, it's a glucose and a fructose. Any information you can give us regarding effects of other kind of sugars in the diet, how it affects the brain? In particular, we could talk about fructose, which is found in a lot of fruits and galactose and diet and dairy. Do they have any particular effects? Is it really just more the blood's glucose level as controlled by our body?
Dr. Dalia Lorenzo:
So in particular, with fructose, you can have less of the myelin, which is found in the insulation that surrounds nerve cells, and they've actually shown in animal studies that the brains have less of that insulation. And the insulation on nerve cells is very important for that nerve cell ... that neuron to be able to conduct the information, the electrical impulses, very quickly.
Dr. Jonathan Fialkow:
Yeah. So, it's not to say fruit are bad for you. Far from that, but we want to make sure that when we talk about the brain using glucose for energy, it's generally glucose that can be from the diet, but the body will manufacture the glucose it needs, so we don't want to hyper concentrate on eating sugars because it's good for the brain. I think that's the take-home message. So to that end, what are some of the effects of sugars on the brain? Sometimes they say sugar ... Is it more addictive than cocaine to the brain? Is there any evidence to support that kind of comment or thought?
Dr. Dalia Lorenzo:
Any substance that is able to stimulate that dopamine sort of rewards circuitry in the brain, it has a potential to become habit-forming. Addiction is a strong word, obviously, because addiction implies that you are going to go out and seek out the substance. There is some evidence that sugar can become very habit-forming.
Dr. Jonathan Fialkow:
As you say, yeah, addiction might be a strong term, but certainly habit-forming, craving, lots of other neurological reasons why people really find it difficult to give up sugar, should it be for their health, which we'll continue to discuss. So, if we're saying that sugar in the diet, especially in its simple forms like fructose and various other forms, might have some negative impact, then by using artificial sweeteners, would we be obviating that negative impact? And people say, "Well, I use artificial sweeteners, so now I'm healthy, and my brain benefits from this." What's your thoughts, and what's the experience on that?
Dr. Dalia Lorenzo:
You're negating a lot of the caloric effects. You are using substances that have other drawbacks and specifically drawbacks that can affect you in the brain. There's many different types of artificial sweeteners. Aspartame is metabolized to an amino acid, that is aspartate, which is actually a very stimulatory neurotransmitter. So, that substance actually will overstimulate the nerve cells, and if there's a lot of it, it can overstimulate the nerve cells to the point where it damages or kills the nerve cells. There's a few amino acids that will do that. Aspartate is stimulatory. Glutamate is very stimulatory, and that's found in other food substances that we're exposed to, like monosodium glutamate. Also in a lot of energy drinks, there's taurine. Taurine is another stimulatory, the neurotransmitter. So, you have to be a little cautious because you're trading one thing for another, so you're not having the caloric intake, but you're now exposing your brain to other effects.
Dr. Jonathan Fialkow:
So yeah, we could agree on that in many parts of our body, but what I'm hearing from your expertise, artificial sweeteners are not necessarily better for anyone than sugar.
Dr. Dalia Lorenzo:
Correct.
Dr. Jonathan Fialkow:
Both aren't great.
Dr. Dalia Lorenzo:
Correct.
Dr. Jonathan Fialkow:
Is that in a nutshell? Right. So, people shouldn't be fooling themselves on going sugar-free, and I'm drinking all these artificial substances, that's necessarily better. And as you're saying, there might be some data to support that. What about some other, again, brain health [inaudible 00:08:20] terms, anything specific towards dementia, aging population dementia, certainly a concern.
Dr. Dalia Lorenzo:
Yes. Yes.
Dr. Jonathan Fialkow:
What are the correlations there?
Dr. Dalia Lorenzo:
As you can imagine, if you're taking artificial sweeteners that are doing all of this overstimulation, that is damaging brain cells, I mean, over time, you can develop damage to the point where you have memory issues and you can develop dementia as this process gets worse and worse. So definitely, there is a link. There has been a link established in epidemiologic studies that there's a higher risk for developing dementia for people who use the artificial sweeteners.
Dr. Jonathan Fialkow:
So what do you ... If you're seeing your patients and they're talking about whether it's diminishing the risk of dementia or even just general brain health, clear thinking, whatever we want to look at, memory, are there any kind of dietary recommendations you make? Or would it be more important dietary recommendations in terms of what to avoid? Do you discuss that at all? And if so, what do you generally recommend?
Dr. Dalia Lorenzo:
There's a few TED Talks that I refer my patients to that are by Neal Barnard that are power foods for the brain. What he does there is he gives you kind of a summary of nutritional evidence in terms of reduction of risk for dementia. So I usually just refer them to that, but there is some evidence in the dietary world that's ... what you do in terms of the foods you eat and everything over time can be protective against dementia. And the other part, which we had talked about earlier, is the exercise. Exercise also has been shown to be pretty protective as well.
Dr. Jonathan Fialkow:
So yeah, let's take a few minutes at the very end of the conversation, again, this is wonderful information, to go over a couple of other points. And I do think by the way, we're able to put those links to the TED Talks in our program notes so the listeners can look forward to that. Thank you. So talk about some other lifestyle things while we got you, physical activity, exercise. So again, avoid dementia, powerful. What's the message we get from staying physically active, especially as you get older?
Dr. Dalia Lorenzo:
Staying physically active is one of the very important things for overall health, as we know, but especially for brain health. And there's actually been studies in not just dementia, but in Parkinson's, in Parkinson's disease where exercise programs are very, very good for keeping the brain as healthy as possible during these, unfortunately, neurodegenerative conditions that are progressive.
Dr. Jonathan Fialkow:
Sure.
Dr. Dalia Lorenzo:
So, exercise is a very important thing. The other thing is, I'm going to make a plug for something.
Dr. Jonathan Fialkow:
Yeah. Sure.
Dr. Dalia Lorenzo:
When I see a patient that is coming to me with problems with memory, we go through a very systematic check of things that might be causing it, what medications are they taking that might be impairing their memory. But one of the things that I focus a lot on, because I find a lot of it, is sleep apnea.
Dr. Dalia Lorenzo:
There are so many people out there, in the 60s in men, it's one in four men will have sleep apnea. There'll be snorers, they have sleep apnea. And that is something that really exposes the brain to low levels of oxygen day after ... I mean, night after night, week after week, year after year, that amount of low oxygen does damage over time. Okay? We know that it will cause changes in the MRIs, like more white matter changes, what we call white matter changes. So, that is one of the things that I really focus on when I get a patient that is coming to me with memory issues, I want to know, is this someone who is being exposed to these clinically significant levels of low oxygen while they're asleep? Because that's going to do more damage, I think, than even the sugar problem.
Dr. Jonathan Fialkow:
Sure, sure.
Dr. Dalia Lorenzo:
So for me, that's big on the radar.
Dr. Jonathan Fialkow:
It has to be said, and I appreciate that, and that, and exercise, these are lifestyle changes. And the thing with sleep apnea, as we all know, is an individual cannot say they do not have sleep apnea because they're asleep when it occurs.
Dr. Dalia Lorenzo:
Correct.
Dr. Jonathan Fialkow:
So, we got to go looking for it. Couple of other just quick substances. Alcohol, we talked about sugar and other dietary things, is there an impact of alcohol? Is it related to the kind of alcohol, the amount of alcohol? Can you speak to that for a second?
Dr. Dalia Lorenzo:
Alcohol, obviously, we have a lot of epidemiologic evidence that it reduces risk for things if taken in moderation, and there's actually recommendations that are made by American Heart, as you know, about what are the limits to alcohol. But in the end, alcohol is a toxin. It's a toxin, and the nerve cells are very sensitive to these toxins. So I mean, as you can imagine, if you're taking a drink and you feel the buzz, that's already telling you that the nerve cells are being affected by it. So, the nerve cells that are most sensitive to the alcohol are going to be in the cerebellum.
Dr. Dalia Lorenzo:
We talk about the brain a lot here, but you know, there's nerves that go out to your hands and your feet. And over time, regular, maybe more than moderate alcohol use, can cause cumulative damage to these nerves. And so a lot of people down the road are going to have a lot of coordination and balance issues. And you know, also the more you use, the more you're going to damage the brain cells.
Dr. Jonathan Fialkow:
And then my last one before we wrap up, and obviously can be related to sugar and artificial sweeteners, but what about specifically caffeine? Are there any specific concerns or benefits to coffee?
Dr. Dalia Lorenzo:
Well, you're talking to a caffeine addict.
Dr. Jonathan Fialkow:
I'm with you, kid.
Dr. Dalia Lorenzo:
You may want to take it with a grain of salt, but actually I will have to say that caffeine use in epidemiologic studies has been shown to be protective for Parkinson's.
Dr. Jonathan Fialkow:
Amen.
Dr. Dalia Lorenzo:
Okay? Yeah. Yeah. I'm sorry to say it.
Dr. Jonathan Fialkow:
It's okay.
Dr. Dalia Lorenzo:
But there it is. You have to look at the bright side of it. You know, obviously, caffeine has other effects, I think, that are going to become more obvious, such as the tachycardia when you're using too much. Caffeine has its benefits too.
Dr. Dalia Lorenzo:
However, once your brain is habituated to a certain amount of caffeine, the withdrawal can really, really impact the way that people function, right? So, all you have to do is miss your morning coffee and before you know it, you're in a brain fog and you're having headaches, and that withdrawal can take about up to a week to go away. And there's some people who are very sensitive to the mood alteration, the agitation, the restlessness that comes along with caffeine, so it's really a case-by-case scenario. Those are things that it's best to just do the research and see if it's for you or not, and there's just ... moderation is always a good rule to live by.
Dr. Jonathan Fialkow:
And that's the great take-home point to end with, not to be fearful of everything we put in our mouth and put in our bodies, but certainly be cognizant of taking things that are, at least, in its most natural form. And again, to me, the brain needs sugar, as we say, but it doesn't necessarily mean you need to eat sugar for the brain to get the sugar it needs. And I think there's some disconnects in our society. There's great, great information. Artificial sweeteners, not necessarily beneficial or protecting you in any ways than sugar would. Both pretty much bad. Drinking in the most natural ... Eat things in the most natural form, makes a difference. Be active, get a good night's sleep, and if you have disturbances, get it checked out. So again, great information. Any final comments or anything to reiterate before we close up?
Dr. Dalia Lorenzo:
No, thank you very much for inviting me. I had fun.
Dr. Jonathan Fialkow:
Great, great, appreciate it. And to our listeners, as always, if you have any comments, thoughts, or ideas for future topics for podcasts, please email us at BaptistHealthTalk@baptisthealth.net. That's BaptistHealthTalk@baptisthealth.net. Thanks for listening, and until next time, stay safe.
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