This is one of the laboratory areas that we have here. We have some of the counters fuse for radio immunoassay procedures Radioman Osa is a mechanism by which we can measure various hormones in the bloodstream that are present in very minut concentrations of by using antibodies to these hormones and radioactive labeled competitors for binding to these antibodies. That's a very complex subject.Let it be said that the most recent Nobel Prize winner was it one of the people who had developed the systems for Radioman Osa for hormones? Okay. Here we have another one of our laboratory technicians working on one of the radio Manasseh is involved in my study in this laboratory. We have other more simple chemical determinations, which are done specifically this Nifty little machine we have here and give us a blood sugar reading in about ten seconds of glucose analyzer. It's called and we have another older machine that has been used over the last decade for measuring other substances in the bloodstream specifically creatinine in blood urea nitrogen protein metabolism products that are used to assess renal function or kidney function. Sugarcane was first cultivated in India. Perhaps sometime in the Middle Ages and then the sweetness of it became quite a rarity X was a type of food that has a has a Crusaders discovered it in the Middle East the the only people that I could have Ford sugar during the early part of the Renaissance in the late Middle Ages were those of the nobility to the Kings and and sugar what was quite cherished over the last two centuries or so sugarcane has been cultivated throughout the world and sugar beets have been discovered his since the time of Napoleon and that allows say colder climates such as ours to raise and processed Sugar Sugar consumption has been going up over the last century rather. Play in most countries. There are several reasons for this one is because sugar is obviously very very palatable as the other reason is an economic one. You can grow more calories per acre in the form of sugarcane, then virtually any other type of crop and well sugarcane produces only one of the important types of food that doesn't produce half a dozen produce protein that produces only the carbohydrates in the form of sugar is one of the cheapest forms of calorie is in for the starving Millions throughout the world. It's a very very important source of calories in the American diet today. I guess that I've heard an estimate of something like three grams of sugar per kilogram body weight per day for children and 2 grams per kilogram body weight per day for adults. This works out too perhaps For the average adult male weighing 70 kilograms are 150 lb this works out to about 4 oz of sugar per day and that it works out to a total of maybe a 50 kg per year and that is equal to about 120 pounds per year for the average American. This is perhaps a stable level there have been studies done through comparing the amount of sugar consumed throughout Western Europe decade-by-decade in one Society got rich enough to be able to afford to take large amounts of sugar most societies have kind of plateaued at had this level. I'd rather countries such as United Kingdom and Switzerland where sugar consumption is even greater than it is in the United States. It's not really a Great deal more than a 50 to 60 kg per year per person. But I just a little bit ahead of of the United States and even though more sugar than that is accessible people as a whole different kind of been satiated with that much sugar in their diet. They have not been eating a great deal more than that as an average and Dawn Lane of your Chief dietitian for the clinical research center averages are always deceiving. What can you tell us about the quality of sugar do Americans consume. Where does most of it come in our diet? First of all the statistics that we have some from some sources such the eye has USDA do prove the point that Donna dr. Bonner is making is that total sugar consumption has not changed that much in about the last 50 years people are consuming about the same same amount of sugar now is they were in the early 90 hundreds the difference that we see is this is that as far as the total sugar consume less of it is consumed in the home that we as individuals may add sugar to our cereal or in food preparation and more is coming to us through industry and such forms is soft drinks some of the sugar used in Canning sugar used in sweetened cereals and these food I am so although the individual Homemaker may think that she's cut down the amount of sugar in the household probably hasn't if you look at per capita in take the other point that one has to consider is that when people think of sugar intake they usually think of common table sugar or sucrose and this does account for about two-thirds of the sugar intake for most people but there are many other sources of sugar that are very similar chemically That many people may think I do not have the same effects as table sugar or granulated sugar. Some of those are raw sugar invert sugar honey, molasses corn syrup solids, all of these are really forms of the same sugar. If you look at it chemically in that is that they're simple sugars that break down glucose and fructose will be talkin about how those sugars that react differently it with the chemistry of our bodies and we'll get to that in a moment. As you were talking about the difference in our consumption of sugar from 50 years ago to about now. Do you think that we were a healthier people love before we began consuming as much sugar as we do now? I think one of the differences between the 50 years ago. And now as far as our consumption of sugars that the main reason for including sugar in the diet are really carbohydrates in general is for a fuel source for an energy source, and it's a very important part of our diet in that is far as the body's concerned that's its first major need is energy. So if the individual has a diet fits depleted of carbohydrate, what they're going to do is take the protein sources and use them for an energy source rather than tissue building and body repair. So when we talked about carbohydrates and that includes sugar, we think of it as having a protein sparing effect and one of the major differences between that our energy needs now and 50 years ago is that we are not as active population. We didn't have in fifty years ago. They didn't have all the modern home appliances that we have now, they didn't have riding lawn mowers. They didn't have many of the things that make our our life much easier. And so what we need to look at in those that turns is that very often sugar or similar type of ingredients are what we call empty calories. They provide the fuel but nothing else. So as we become a less active population, we may need to look at cutting back now. That's just one of the factors is the excess calories. Are you gave us a short summary of some of the economic reasons for why sugar has become so important to our diet. I'll put the same question to you. Do you think we were healthier when we were consuming less sugar? Well, that's a hard question to answer. I think the health has changed back in the days when sugar was a rarity. There were many infectious disease problems that were really limiting the life expectancy of the population. Tuberculosis is so one that comes to mind for most northern European culture is in American cultures. And I think that with the elimination of many of the problems the human being has had the opportunity to live to its full life expectancy, and this has become very much the reality over the last 50 years or so, and I think That the importance now of considering are we eating too much. We finally have too much to eat too much sugar and too much fat is a very real consideration. Don't when we talk about energy expenditure. I think the the one thing we should also keep in mind that is also a current concern is the intake of fat that we have in the American diet fat provides twice as many calories per gram is carbohydrate. So when we're really talking about changes in energy need we can't talk about them without looking at fat content of the American diet thing about to the use of sugar I'm hungry as groups of people. I was interested not only in children and adults but very is socio-economic classes people have money people who don't have much money. What are we seeing the rights of sugar use some groups of people who might be poor compared to those were relatively rich well, it is a known fact that food costs are rising and one of the food groups. That's the most expensive would be the protein Source Foods. There are course proof protein foods that are fairly reasonable and price at to fill goons. Some of the items stolen that dairy group, but particularly in this part of the country were a meeting population. And so this does affect the lower-income person in particular that that person generally is going to have to use a higher percentage of of a carbohydrate in the diet to take care of the energy needs for example of a growing child. Let's get back to discussion of the different kinds of sugar because this is another question that we hear a lot these days is is there a difference between refined sugar and hope all natural sugars? And dr. Bonner distinguish for me. If you would how refined refined sugar or sucrose reacts with the body compared to the sugar that we might find in a in an apple or a pear for example. Okay. This is a very complex the topic you have to understand several different things sucrose is a chemical term for what we call table sugar and table sugar or sucrose is one of the chemicals that we have in the household. It's made from either two major sources either the sugar cane or the sugar beet and the sugar beet is more common than they are in the Upper Midwest the sugar that we find in Apple's Aura most fruits is a combination of two different types of sugars fructose and glucose. Actually, these two sugars fructose and glucose are joined together to make the sucrose molecule. The difference perhaps is not so much as far as chemical Purity. We could certainly purify sucrose and fructose and glucose out of the Apple, but rather the things that come along with the Apple, there is a great deal of what we call cellulose or Fiber in the apple. And there has been a great deal of suggestion lightly over the last five or ten years that this this fiber is a good additive to the diet. It has some positive effects as far as cholesterol levels. It has certainly some positive effects as far as the function of the GI tract or the got in general and I must say that during the course of my residency. It was quite astounding to me that we are seeing Quite a few people coming into a clinics subspecialty Clinic sting dealing with it gastrointestinal disease who have eliminated all sorts of fiber in their diet and have tremendous problems with constipation people that don't have a bowel movement except for maybe once every other week and something that would rather shocking to me as an otherwise reasonably healthy person and I guess that when you get to the point of extremes of eliminating all sorts of a crude fiber is a scene in grains and fruits and vegetables and you would limit your diet to refined sugars and starches and fats and protein sources that don't have much in the way of fiber in them. You can really Had suffered some adverse effects of a low residue diet and I think that the differences as far as refined or crude sugars are the various types of sugars chemically are not as important as the other fiber along with the sugar taken in the diet. If I take a if I eat a piece of fruit and compare my reaction after eating that piece of fruit which contain sugar at compared to spreading the sucrose on my breakfast cereal will I feel differently as a result of taking one or the other sugar? It depends how much sugar do you use on your breakfast cereal an average piece of fruit. Then let's consider a unit 1 apples of unit R1 orange is the unit has about the quality of carbohydrate is 2 teaspoons of sugar would have and the sugar in the orange of the apple is dr. Bonner Mansion is already in a simple form. It's already broken down to glucose + fructose. So it's metabolized very quickly. Just is that table sugar would be yes. Not not really the carbohydrate of the three foodstuffs is metabolized. The quickest. The one thing that you do have to consider is how you're eating at you for example, you just take a teaspoon of sugar put it on a spoon and put it in your mouth. It would be metabolized more quickly than eating it in a mixed meal as a breakfast be Is then you're adding some protein and fat with it and slowing down the use of it. How do you respond to people who say that there is a difference in the kind of sugar that is if weeds or so-called natural sugar we are better off for it. Then if we eat so-called refined sugar. Now that they're died is made up of large, night combination of refined foods, and I think that's a legitimate concern. There are many reasons why we don't want to refine the diet too much. There are many nutrients that we really don't know what are requirements are for yet that maybe in the food before it's refined. Now some of that is taken care of by some excellent program programs of fortification are enrichment that we know that interest use providing yet. They can only fortifying enriched the nutrients that they They know where they're so that it is probably a very reasonable concern of people and looking at it is in particular with one food sugar. I think there's some foods that have been more popular as far as the question and one has been sugar is dr. Bonner mentioned sucrose or table sugar is very refined to about the point of 99.9% but raw sugar that many people think is a more acceptable choice is also 97% refined. So there's not a large difference and then looking at a product such as sugar as to the other nutrients that could provide for example of trace minerals, we would hope that the individual wouldn't eat so much honey or table sugar or any of the other sources that they were using it as a source of the trace minerals in their diet. You would have to consume a huge amount per day to provide that about the only Sweetening agent that I can think of that in small quantities would really be a good nutrient Source other than calories would be molasses molasses is a good source of iron and some minerals my other concern in regard to the individual that's that thinks that there's a real difference between refined sugar and natural sugars that probably one of the most important concerns we have for sugar in the diet is Dental Health dental caries, and whether you're using table sugar or honey in your cookie recipe. They have about the same effect on plaque formation and the opportunity to form Dental caries. Will your doctor about are you talked about 1 disorder related to the elimination of fiber from the diet problems with the gastrointestinal system? What about the abuse of sugar if we can call it that people just eat too much sugar? What are some of the symptoms we see in people who consume too much while first of all, we don't exactly know what what is too much. We know that that people can get a beast or fat. We know that with the extremely large amounts of sugar. There are modest changes as far as the fat content in the blood have I mentioned before that. Perhaps is an average. The American is consuming two grams of sugar per kilogram per day. And even though these are in metric terms. I guess we have to begin to think in those terms since the sooner or later. We're going to be using them uniformly an even in the united in the United States than the last if you double that amount to Apps for grams of sugar per kilogram per day. We begin to see some modest changes as far as some of the fats in the diet cholesterol may be minimally effective but perhaps more importantly is another one of the neutral fats in the diet that we call in medical pylons triglycerides at the cholesterol has been the substance has been most closely associated with heart disease triglycerides. We're not really exactly sure at this point how significant elevations of these paths in the in the body are as far as producing a heart disease Our concern is that with excesses of sugar in the diet or maybe some long-term effects as high as heart disease, but we really have no firm data at this point to Say that there is any definite association between true accesses of sugar and heart disease or any other type of disease and perhaps one of the ways we would Define excesses the level at which we begin to see some of these some of these changes we see the levels in the blood change, but we don't really yet have the correlation with the disease aside from Dental cavities. What about the high consumption of sugar in kids? Is there something detrimental that'll happen to their bodies if they consume sugar over a long. Of time at high levels? Well, I would have to say as of this point. I don't know of any and I don't play Medical Science as a whole has any clear-cut understanding of the problem. This is an area that has been perhaps more intensively studied over the last 5 or 10 years and it has been over the previous two thousand years. There is no dramatic changes that we know of yet with the children who are eating 3 grams of sugar per kilogram per day as opposed to those who are eating a half that amount 3 grams is pretty much the standard there is perhaps a Multiple effects worth putting fluoride in the drinking water or seeing decreases in cavity formation because of that were perhaps adding more refined sugars or more sucrose in in the diet and the various prepared foods that we use typically the soda pops and everything else from breakfast bars right through the TV dinners. But as of yet we don't even know for sure. What effect this is having on on cavity formation. I think that it set his hearts are dental colleagues are concerned cavity seem to be formed not only buy lots of sugar in the diet, but also because of certain bacteria in the mouth that lead to break down of the enamel in the teeth, and it's a difficult type of Study to perform to study not only the bacteria in the mouth but also the sugar in the diet over a long-term of five decades and in populations, if it becomes a multimillion-dollar effort in order to really study these things accurately, unfortunately, sometimes various people have studied one aspect and another aspect and they often get conflicting results your question about the concern of the high percentage of swedes or table sugar whatever you want to refer to it as in the diet of children. There are some studies that back up a legitimate concern with this study such as that NC state survey that point out if children are eating these Foods as a selective choice and eating them to play something else in the diet. We may easily C deficiency states that could lead to other diseases and examples of the deficiencies. We see in particular are with by Can a vitamin C and calcium? Those are the three major nutrients we find lacking in the diet of a child make takes a large portion of sweets an average person to know when someone is a child especially is consuming too much sugar that might lead to that problem. I think one of the major nutrition education as you know, this is becoming again a current interest of the population and we have many things that make it easier for the consumer to tell if their diets adequate particular things such as nutrition labeling where they can read the package they can see what percentage of the carbohydrate is in the food and of that carbohydrate what's table sugar sucrose or other form similar and then there will be other information on what are known as the rdas are recommended daily allowance is so it will say if the product contains 10% of the calcium needs this kind of thing. So if the person's really pay Attention to what they're buying they should be will tell if they're meeting the requirements for the major nutrients in their diet. I think that's kind of a loaded question in many respects people have enjoyed the flavor of sweetness for four generations. I don't think that people at least not the people that I've come in contact with have had any withdrawal pangs from that sugar. I do find that it's very difficult to get people to lose weight in the clinical setting where obesity is a problem. I think that total calorie restriction is something that's difficult to achieve. I think that it is sugar is not addictive in the sense of heroin being addictive. I think that it's perhaps best to use less emotionally overtone words when talking about sugar consumption and then to say is sugar addictive have it has no withdrawal problems. As far as I said the usual types of things that we see with drug withdrawal and the price is simply one of preference to prefer to have something sweet versus something that has fiber is associated with it. We know the food companies are adding more sugar now than they have been in the past to various food products. And of course, there's more of everything being added to food products. Is this solely to get us to eat the food price to buy more of the food products are increasing the level of sugar are there nutritional reasons for increasing the level of sugar? One of the nutritional reasons if you could call it such would be as preservative Factor sugar is one of the preservatives that we've had for many many years was one of the first and that was one of the first reasons we saw included in food what we're saying now at yes, it's been included more as a flavor enhancer. It also has effect on the protein molecule referred to tenderize it. So you'll see it sometimes included for that reason it sometimes is included for a color if you heated to a certain degree, you can get a car sound effects of sometimes it's it's to make the product look better. There are a number of reasons. I think when we're talking about the cost and the fact that it still is one of our least expensive food sources and also is used in some cases to increase the caloric density without increasing the price of the product. Then many of these little packets that you open up pouring into a cop and then add some water to dissolve it to make either a new anything from my from soup to Hot Chocolate to the sugar added in helps to dissolve the the substance and that's the only one of the many reasons why it may be included in and various pre-packaged shrimp prepared foods.