Doctor's Note

This underscores why a whole foods, plant-based diet is preferable to a plant-based diet that includes processed junk.

I’ve touched on the harm of refined sugars before in:

For healthful alternatives in baking, see The Healthiest Sweetener, and for beverages, Erythritol May Be a Sweet Antioxidant.

But what about the fructose in fruit? How much fruit is too much? I’ll be addressing these questions in a series of videos coming soon. And I’ll also be doing more videos on the burgeoning epidemic of nonalcoholic fatty liver disease and what we can do about it.

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  • guest

    I eat 30 dates a day, 15 bananas a day. 1 mini watermelon. 5 apples. This is not my whole diet – I eat a low fat diet, with some grains and veggies. Is this too much sugar? Too much fructose in these fruits?

    • Marlon

      if you are active I don’t see a problem with it. In an interview Usain Bolt says he eats 5-10 a day and Yohan Blake around 16! They also eat lots of yams and sweet potatoes.
      However it could take a toll on your teeth. (the dates)

      • Sexy On my way!

        Love yam jamaica

      • Dave

        Usain Bolt and Yohan Blake are also elite athletes.

        • Marlon

          So you are saying that unless we are fit we shouldn’t be consuming this amount of fruit?
          So… if you want to be an athlete…. you consume a healthy diet and then once you are labelled an athlete by people like yourself it is ok to eat heaps of fruit?
          I don’t see the logic. If you wanna be an elite athlete you should consume the fruit before, not after you are an athlete.

          • kate56

            What you want to do is have your triglycerides checked. The way the liver disposes of excess fructose is to convert it to triglycerides. If your triglycerides are high then you’ll need to either cut back on the fruit or up your exercise to burn off the fructose-based glycogen in the liver before it can get converted to triglycerides.

          • http://twitter.com/MacSmiley MacSmiley

            Actually, fructose metabolism has been traced: the human liver converts 50% of fructose into glucose and 30% into lactate. In humans, only 1% is converted into fat (triglycerides), whereas rat livers convert 50% to fructose into fat. Earlier studies of fructose was done on rats which overstated the dangers to humans.

            That doesn’t mean that we should flood our livers with massive amounts of HFCS, because it may keep the liver preoccupied doing fructose conversion to tend to its other detoxifying duties.

          • Arjan den Hollander.

            Mmmmm that might be the variable to monitor in relation to dry then red patches just next to my nose every now and then.
            Does it work like that, liver work overload, and liver then postponing other work in favor of your example fructose?

          • http://twitter.com/MacSmiley MacSmiley

            According to Scientific American, yes.

            http://blogs.scientificamerican.com/brainwaves/2013/07/15/is-sugar-really-toxic-sifting-through-the-evidence/

            However, another source I read gave the potential toxic dose of fructose at 100 g per day. Since nobody eats pure fructose, and since it is usually paired with an equal amount of glucose, that would mean an intake of 200 g of table sugar or HFCS. That’s between 6-7 oz of sugar. That’s the equivalent of 5 cans of Coke.

            OTOH, Kempner’s Rice Diet included huge amounts of sugar. Some patients consumed up to 400g of sugar per day.

          • Neil

            Can you provide the sources for this info? Thanks.

          • http://twitter.com/MacSmiley MacSmiley

            The sources are linked to the article. Just search the page for the word fructose. It appears only twice.

            Is Sugar Really Toxic? Sifting through the Evidence

            http://blogs.scientificamerican.com/brainwaves/2013/07/15/is-sugar-really-toxic-sifting-through-the-evidence/

    • http://nutritionfacts.org/ Michael Greger M.D.

      I’ve got another video coming up called How Many Fruit is Too Many? Stay tuned!

      • guest

        Really looking forward it. Fruit indulgence ****excess consumption has a divided jury, and maybe you’ll

        help clear the division. I think a lot of heavy fruit eaters aren’t sure if they are causing themselves long-term harm –

        ***by heavy I mean the amount of fruits listed in the top post “30 dates a day, 15 bananas a day. 1 mini watermelon. 5 apples” a day.

        • bob

          Every time I binge on fruit…like a bag of oranges….I end up having what I assume is yeast overgrowth. I’m doubting that it is healthy.

          Likely you are indulging in a post-prandial sugar high that you are trying to maintain? Kids like sugar…it’s a high. Real men go out and kill something. LOL.

          If I indulge too much…I can have a hypoglycemic reaction. I notice older people don’t like sugar so much…probably can’t process it as well?

      • Laloofah

        That’s nice, but I’m breathlessly awaiting your “How Much Air Is Too Much?” video. ;-)

        • http://twitter.com/MacSmiley MacSmiley

          ROFLOL!!

        • Han

          Hyperventilation can be a serious health risk! :P

        • sf_jeff

          I don’t think it’s the quantity per say, but rather the degree to which it is “Hot” that is the real thing to watch out for.

          • Laloofah

            LOL, good point. :-)

      • RonB

        Looking forward to see your fruits video.
        However: you need to work hard to convince me that there is a large difference between dates / bananas
        and sugar. In the end, both contain mainly sugar (fructose, sucrose & glucose). Fruits contain also dietary fiber,
        but that does not convince me that that it’s good enough.
        If you eat 3 dates it’s like eating 8-9 tea spoons of sugar. If sugar is bad then at least some of the fruits are bad.

        • http://twitter.com/MacSmiley MacSmiley

          Agreed. Biochemically there is no difference. The reason fructose “hits” the liver is because liver cells are the only cells in the body that can convert fructose to useable glucose and other sugars.

          Alarmist Lustig MD has been influenced by patients whose hypothalamuses have been damaged by brain tumors. He’s wrongly extrapolating to the general public. His rhetoric is peppered with inaccurate statements. Mark Hyman’s statement that sugar is 8x more toxic than heroin is just plain irresponsible.

          BTW there is a concerted effort by the animal food industry to shift the blame for heart disease and diabetes on the saturated fats and cholesterol in their products to sugar and carbs in general, which includes the funding of headline-grabbing junk science studies one of which was just published in PLOS One. The attached image comes from the Beef Checkoff Program…

          • Arjan den Hollander.

            Mr. Lustig must have built up a formidable tolerance to heroin, 24 hr a day drip for the past decade? ^^

            On a serious note, I do hope the limit on fruit will be a high one.
            I suspect eating zante currants as candy up to and every now and then over a 100 gr a day might be pushing the limit.

      • alinta

        Hi Dr can you please do a video on Coconut sugar.. so many people eat a lot of it and i want to know whats the deal :) thanks !

    • Sexymoma

      Eating fruits is ok

    • Ellen

      Yes, too much sugar natural or not. Look at JJ Virgin’s new book, Sugar Impact Diet

      • Dave

        I’m illiterate — what’s the gist of the book? Sugar bad — high fat good? Exercise more? Lose X pounds in a week?

      • http://twitter.com/MacSmiley MacSmiley

        J J Virgin is marketing, pure and simple.

    • mjs_28s

      I wouldn’t be concern about varied whole food sources of sugar. The video was focused on added sugars to foods which is much different than just the compound we call sugar.

      • Wegan

        According to Lustig, the fiber in the fruit is the antidote to the toxicity of fructose.

        • Israel Navas Duran

          And do you believe that?

          • Adrien

            There is no reason not to beleive it. Increasing fruit and vegetable consumption is one of the least controversial thing somebody can do for health promotion. Fruits and refined sugar are not the same thing..

        • http://twitter.com/MacSmiley MacSmiley

          Lustig’s premise is faulty. The difference between fruit and the sugar in processed foods not fiber but dosage.

          • mbglife

            I think you’re missing the Lustig’s points in that single statement.
            1. You’d have to eat a lot of fruit to get the same impact as in a glass of cola or fruit juice.
            2. The fiber releases the sugar slowly so it hits the liver slowly. The higher doses in cola & fruit juice hit the liver all at once.
            3. He also distinguishes between HFCS and other sugars, including old fashion sweeteners like Karo syrup.
            I’m not sure how much of what he says is correct, but I think he has some good points.

          • http://twitter.com/MacSmiley MacSmiley

            I understand Lustig’s points better than you think I do. (Google “Robert Lustig criticism”. Search for Lustig’s name at http://carbsanity.blogspot.com) The man is a buddy of Atkins/low carb high fat proponent Gary Taubes, and just like Taubes, he oversimplifies and misrepresents facts. To Lustig, it is sugar ALONE that is responsible for obesity, diabetes, and heart disease. (Taubes blames pretty much all carbs.)

            The problem with sugar in any form, including HFCS, is not that it is toxic in and of itself but that it is used to make non-satiating but calorically dense processed foods more palatable, causing passive overconsumption of calories, anywhere from 300-700 calories/day. Those calories include flour and added oils (carbs + fat + protein).
            Add that to sedentary lifestyles, and you have a perfect storm of caloric excess. THAT’s what’s toxic.

        • http://twitter.com/MacSmiley MacSmiley

          Satiety counts. Refined carbs are not very filling.

          Fiber and water in fruit can curb the amount of fructose consumed and slow down its release somewhat. But nullify toxicity? Nope. Lustig is SOOOO inaccurate in his biochemistry. Even practicing low carb high fat biochemists have called him out on his epic wrongness. One can only wonder at the sensationalist publicity he’s gotten. Must be because he’s such a buddy with Gary Taubes.

      • http://twitter.com/MacSmiley MacSmiley

        The difference is dosage. Sugars by any name, be it glucose, fructose, maltose, lactose, etc., are all biochemically identical regardless of the source.

        • mjs_28s

          The difference is source.

          Yes, chemically a sucrose molecule is the same regardless. However, just looking at sugar as a problem means that one has to ignore the rest of the food and thus, all the other benefits or bad things.

          Example – is eating two apples as bad for you as drinking a soda even though they have about the same sugar content?

          Clearly not. Focusing on a single nutrient will lead to malnutrition. This is why many supplements don’t work well or at all. They are missing other key compounds that they normally arrive in the body with when they are in whole food sources rather than a single compound isolated from thousands in a food.

          • http://twitter.com/MacSmiley MacSmiley

            I didn’t say a can of soda is nutritionally superior or comparable to a couple of apples. You miss my point.

            People are freaking out about sugar because of saturated fat apologists/sugar alarmists like Lustig and sugar-is-8x-more-toxic-than-heroin Hyman.

            My own cardiologist eats UNRIPE fruit for fear of the sugar content. This is just crazy!

            Plus…

            This anti-sugar campaign is all part of the animal food industry’s objective to frame carbohydrates as THE primary cause of heart disease, obesity, and diabetes while exonerating their own products with pay-to-publish junk science studies that grab the headlines.

          • mjs_28s

            I apologize for misunderstanding.

            I think I read your post with my inner monologue whispering into my ear that you were another sugar fighter regardless of source.

            I might need to go eat a few more carbs and then re-read the post again :-)

          • padutchrunner

            You are absolutely right on, MacSmiley!!

        • Eva

          To add up a bit to the conversation – I watched a pretty nice experiment with two identical twin brothers, both doctors. They decided to live, for a month, one on a high-fat diet, and the other on high-sigar diet, and see in the end who ends up sicker than the other. The result was interesting, the high-fat diet guy (who ate no sugar in any form) actually ended up prediabetic. The guy with high-sugar content (no fat) had a pretty stable insulin release levels. Of course, before the experiment both had measures of blood sugar, bla bla.. they were both with identical measures. Both had lost weight after the experiment, the guy on fat had lost more weight from muscle tissue than from fat stores. The guy on sugar, lost 1,5 kg of fat. Of course, these two diets are both unhealthy either way, but it clearly shows who the culprit is. Oh, the guy on fat had problems with memory and concentration and when they had to go cycling for 1 hr, the guy on fat gave up very quickly, he was breathing terribly… The final experiment was with mice though. They gave one group of mice only sugar. The mice ate just a normal amount of calories and stopped eating until they felt hungry. They remained lean and behaved normally. Another group of mice were given fat. They also restricted their consumption and didn’t overeat. A third group though was given both fat and sugar in one meal (cheese cake). They gorged until they got lazy and in the end fat. They ate constantly, without being hungry. I am not a sugar advocate but you’re attacking sugar too much. It’s everywhere in nature and animals eat it, and I don’t see why we shouldn’t eat it, or restrict it. My great-grandmother and my mother ate loads of fruits during the summers. My mother has only a few cavities. My great-grandmother died with her own teeth in her mouth, not having lost even a tooth. For me, the bottom line is, if it is a fruit, with all the nutrients and fiber etc, I’d not think about the sugar. I’d consider it when it is out of its natural form. Of course, I am very curious what the next video on too much fruit will show :) (oh, and 15 bananas… I can’t imagine that but you definitely don’t need 30 dates a day!!! There’s plenty of other fruits, you need to have a variety in your meal).

          • http://twitter.com/MacSmiley MacSmiley

            Wow! That’s fascinating about the twins. Got a link for documentation and tweeting??

            Agreed about the fat + sugar being a problem, because it’s not the sugar itself, or even the fat itself, that causes overconsumption. It’s the FLAVOR, the texture, and other physical properties of the food. If it were just sugar alone, we’d all prefer lemons over oranges and Granny Smith Apple’s over other varieties because they are highest in sugar in their fruit categories.

          • Eva

            I watched the documentary on a swedish tv channel, and it had a swedish title, which I don’t remember, but here is an article about the two guys – http://www.dailymail.co.uk/health/article-2546975/One-twin-gave-sugar-gave-fat-Their-experiment-change-YOUR-life.html Anyway, really a fantastic experiment. I loved it! It explained so much about why we overeat and why our appetites are just uncontrollable… and who is in fact the bad guy :) Oh, and it also explains why there is no such food, high in fat and high in carbs in nature. These two are almost always separated, where either fat or sugar is higher in content, and the other reasonably low. I prefer to make my dietary choices based on what the plant world gives us. I am avoid processed fats (even olive oil, since it’s not in its natural form, I just prefer to eat more olives or avocados or nuts for the fatty content) and I am conscious about mixing too much fat and too much carbs in one meal. I believe these are simple guidelines for people struggling with illnesses and obesity.

          • http://twitter.com/MacSmiley MacSmiley

            I found the documentary!!! It’s BBC Horizon: Sugar vs Fat

            http://www.dailymotion.com/video/x1amh2t_bbc-horizon-sugar-v-fat-h264-1280×720-aac-rmac_lifestyle

            Thanks so much for the heads up, Eva. It’s well worth watching!!! I love the way it blows Taubes/Lustig’s dogma out of the water, what ↑ Evelyn “CarbSane” Kocur calls TWICHOO or Taubes’ Wrong Insulin-Carbohydrate Hypothesis of Obesity.

          • Eva

            :) I hope you like it, for me at least it was a brilliant experiment, and most of all the conclusion where it all comes down to,the mix of the two that makes it so addictive…

          • http://twitter.com/MacSmiley MacSmiley

            The take-away from this documentary is good (besides the negative effects of a LCHF diet): The synergistic effect of sugar + fat is hard to resist.

            However, it still is incomplete. There is no fat in soft drinks. But there is flavor from other components… and that fizzy tingling sensation. There’s more going on with man-made foods than sugar and fat.

            I think Michael Moss has enumerated the complexities of human junk food quite well. (1) Salt (2) Sugar (3) Fat (4) Convenience, plus some sub-features like texture, crunch/crispness (including sound), and that melt-in-your-mouth quality. The studies on rats and human junk food also pointed to variety as a factor, as well.

          • Thea

            Thank you Eva for bringing this up and MacSmiley for the link! There were some aspects of that movie that drove me nuts, but over all, I thought it was very interesting–especially the parts related to diabetes. Thanks!

          • Eva

            There will never be a complete video or movie for about 1hr in length. :) I understand many people may be disappointed. But in the end, one can always get some conclusions for oneself, and find something meaningful and important from the whole movie. I enjoyed the whole of it, but the conclusive experiment on the mice was what made most sense to me. :)

          • Thea

            Eva: I completely agree that there is only so much one can cover in an hour. The problem I had with the movie was the way they actively promoted some important misinformation. So, instead of dispelling myths like they claimed, they dispelled some and contributed to others.

            For example, they equated simple sugars (like jello) to “carbs” to whole grains and fruits and veggies. They did this multiple times in several ways–including leading people to believe that whole plant foods do not make one feel full–at least as full as protein. (When in fact the doctor was eating simple sugars, syrup and powdered sugar, and refined foods without the fiber.) Another example is that they outright said that eggs are a “good fat” and do not have saturated fat. That’s just so wrong it took my breath away because I wasn’t expecting it on a show like this. They did some good things to clear up some myths, but that one hour could have been a so much better by simply being accurate within it’s own scope.

            A knowledgeable person can learn a lot from that one hour. But a newbie is just going to end up with a lot more confusion in the end. That’s why it “drove me nuts”. But as I said, I really did appreciate you pointing it out for me. I found certain parts of it fascinating.

          • Eva

            I can’t agree more with you, Thea. It’s just that personally I already know some things for myself (like ‘eggs are not healthy, meat is not healthy’, etc) and I just dismiss sentences like ‘Eggs are healthy’ etc. I watch something or read something only as long as I read something new, or see a new experiment. Usually what fascinates me is when someone tries something on themselves. I won’t believe science completely until I see results after experiments on real subjects. It may sound cruel (and it is for mice at least), but when it comes to humans, I can’t wait to see it. After all, the movie was produces by Horizon, they are pretty mainstream, I am well aware of that.

            Again, the last bit was most interesting for me, personally, because I realised WHY actually we are so blindly drawn towards fatty sugary food, why we can’t control ourselves a bit more. That question haunted me for years, and the movie’s end hit me! :) Again, I just dismiss the outrageous parts and move on. It may be very very misleading for a newbie and I will definitely not recommend it to such a person.

            I take out what’s new for me, I always search for what is untested, or unknown. The Horizon series has other such videos with test subjects (the controvertial and widely hated Michael Mosley), which also show interesting discoveries.

          • http://twitter.com/MacSmiley MacSmiley

            Mosley is widely hated?

          • Eva

            Yes, at least that’s what I read all over the internet, forums, discussion groups, etc… I find his movies interesting, but it seems he’s really controversial for many people.

          • http://twitter.com/MacSmiley MacSmiley

            He is fascinating though! I loved it when he swallowed that pill/camera and we got to see the inner workings of the human digestive system. :-)

          • http://twitter.com/MacSmiley MacSmiley

            I haven’t seen his “meat” documentary yet. Have you?

          • Eva

            Yup, I saw it out of curiosity, but it kind of didn’t show any new unexplored perspectives…. it always comes down to eat less meat or none. He doesn’t like the idea of no meat so he seeks a healthy doze of meat daily. I think you won’t miss anything if you don’t see it. I didn’t learn anything I don’t already know.

          • http://twitter.com/MacSmiley MacSmiley

            Good points, Thea.

          • http://twitter.com/MacSmiley MacSmiley

            Experiments with mice/rats and human junk food started back in the 1970’s. ( Search PubMed for “cafeteria diet”) Hard to believe it’s taken this long to get that information out to the general public!

            When rat chow is spiked with high amounts of sugar, in any form, the animals may binge on the chow, but then they eat less later on. So their caloric energy balance does not change. Even when fat and sugar is added to the chow, they may binge, but they do not overeat.

            But give them human junk food and Ohh Là Là!!!

          • Eva

            :)) Yeah, there’s clearly more than just fat and sugar. And if we add the chemicals, the flavours…. well… things get messy. It’s true that if I eat (I’ve tried that these days) 100 grams of pistachios mixed with 1-2 tea spoons of honey, I feel pretty full when I’m done. Well, I guess I can keep eating since it’s not exactly a wholesome meal, but I definitely don’t have an uncontrollable appetite after that. I guess you have a point… By the way, actually wheat has some chemical that has an addictive effect on the brain. So, if they gave mice cheesecake I think that explains why they never stopped eating it… Thank you for pointing out the junk food part :)

    • Pat

      I hope those are organic apples you’re eating. According to the Environmental Working Group, apples are the number one or two food most polluted with pesticide residue, depending on the year of their annual report.

      • Adrien

        Correct, but I’ll love to see a list of pollutants in animal product to compare. Because I hear lot of people saying that to justify the fact that they don’t eat enough fruit and vegetable. The solution is organic apple, not beef. Even if it’s grass feed.

      • http://twitter.com/MacSmiley MacSmiley

        The vast majority of studies showing the benefits of fruit and vegetables in the diets are done with conventional pesticide-laden produce. Organic produce has organic pesticides. Buy organic for other reasons.

    • Zuppkko

      I eat mostly fruit too, but 30 bananas in one day is A LOT. And there are SO MANY better fruits out there that have more water and more goodness in them.

      • mbglife

        The UN’s Food & Ag Organization website, at http://www.fao.org/docrep/007/y5102e/y5102e04.htm states:

        “The importance of bananas as a food crop in tropical areas cannot be underestimated. In Uganda, for example, annual consumption per capita was some 243 kg in 1996, and between 100 and 200 kg in Rwanda, Gabon and Cameroon. In these 4 countries, bananas account for between 12 percent and 27 percent of daily calorie intake of their populations.”

    • http://www.emilyhoneycutt.com Emily Honeycutt

      Hi guest,

      Wow, that sounds like a lot of fruit, but it’s great that you’re enjoying a variety of fresh whole plant foods. Whether or not this is too much sugar or too much fructose for you depends on a number of factors. Dr. Greger is coming out with a video discussing how much fruit is too much, but in the meantime, here is one video that may shed some light on the topic: http://nutritionfacts.org/video/if-fructose-is-bad-what-about-fruit/.

      Here are just a couple of my thoughts:

      1) Are you at your ideal weight or would you prefer to lose weight? What is your activity level? That might be too many calories and too much sugar for someone who is sedentary, but may be fine for someone who is extremely actively like a marathon runner.

      2) Do you know your trigliceride or cholesterol numbers? While dates don’t seem to raise triglicerides in studies despite their high sugar content, excess sugar is converted to triglicerides (fat in the blood).

      There are many studies, including this one: http://www.ncbi.nlm.nih.gov/pubmed/15370099 and http://www.bmj.com/content/347/bmj.f5001 showing that the consumption of whole fruit reduces the risk of cardiovascular disease and diabetes, while fruit juice does not. However, these studies do not study people who consume the volume of fruit you have described.

      I really can’t judge without knowing your overall health or activity level, but for most people who only get a moderate amount of exercise, I would advise trying less fruit, more vegetebles and the addition of some beans, legumes and nuts and seeds and see how you feel. Regardless, it sounds like you are eating a very delicious and nutrient-rich diet.

      I hope that helps,

      Emily :)

      P.S. Please be sure you are taking B12 too! http://nutritionfacts.org/2014/12/18/the-vitamin-everyone-on-a-plant-based-diet-needs/

    • jameskitchens

      I recently started using date syrup as a sweetener in my cocoa drink made with nut milk. Is that okay?

    • vegan Ronin

      he was talking about processed sugars like HFCS and table sugar, the fruit is okay as long as your getting all of the daily recommended vitamins and minerals

    • mjs_28s

      the problem is not sugars from whole foods but ADDED sugars is the real problem.

  • Tobias Brown

    How does Erythritol fit into this picture? Do we get a by on this sweetener?

  • Jane’s Addiction

    So happy to see this topic, and I’m glad to see that it will be revisited.
    Now that researchers have finally demonstrated a causative link between sugar consumption and diabetes risk I’d love to know just how much one’s risk for diabetes increases given x teaspoons of daily sugar intake (or x% of daily caloric intake, whatever the standard measurement is).

    • HungryVegan

      Jane, the video doesn’t mention diabetes. It says that excess refined sugar leads to liver toxicity and non-alcoholic fatty liver disease.

      It other words, refined sugar is bad for your liver, but it doesn’t make you fat. Fat makes you fat.

      • http://twitter.com/MacSmiley MacSmiley

        Fat makes you fat.

        Actually, calories in excess of the body’s metabolic needs makes you fat, whether those calories come from carbs, proteins, or fat.

        • mblife

          And as I recall, studies presented on NF show that environmental toxins, pesticides, bad diets and other triggers can change the body’s rate of metabolism, thereby affecting how many calories the body holds onto from the same amount of calories under optimal conditions.

          • http://twitter.com/MacSmiley MacSmiley

            Even if something other than food is affecting our metabolisms, that does not negate the energy balance equation. Calories in (digested and absorbed) must equal calories expended or weight gain will result.

          • http://twitter.com/MacSmiley MacSmiley

            Right, what we think we need in terms of calories can change because of environmental factors, however, that does not change the validity of the CICO equation. It just changes the values of the variables. Get it?

        • padutchrunner

          The problem with fat is that it contains 9 calories per gram. For example, one tablespoon of oil contains 120 calories. So, perhaps it’s correct to say that there is nothing biochemically special about fat with respect to metabolism, but we can nonetheless say that fat makes you fat in the purely mathematical sense of the calories in, calories out formula.

    • http://twitter.com/MacSmiley MacSmiley

      Sugar causes diabetes?? Not so fast.

      Have you seen this BBC documentary pointed out by Eva…? Horizon: Sugar vs Fat. It’s the twin eating NO SUGAR for a whole month, who loses MORE weight, who ends up pre-diabetic. Diabetes is more complex than just sugar, as it involves fat and protein metabolism as well as carbs. It’s diabetes which causes problems with carbs, not carbs that cause diabetes.

      Article:
      http://www.dailymail.co.uk/health/article-2546975/One-twin-gave-sugar-gave-fat-Their-experiment-change-YOUR-life.html

      The documentary:
      http://www.dailymotion.com/video/x1amh2t_bbc-horizon-sugar-v-fat-h264-1280×720-aac-rmac_lifestyle

      While I’m not justifying the extreme processed carb side of the experiment (or the similar amounts of heavily refined carbs in the SAD), this is no surprise to those eating all or mostly whole plants.

      http://plantpositive.com/35-how-to-become-insulin-resis/

      http://plantpositive.com/36-how-to-become-insulin-resis/

      In the book about Blue Zones, there’s even a story of a centenarian cooking up his own refined sugar from sugarcane grown in his own garden! Context is everything.

    • Karl Holtzer, M.D.

      Hi Jane. I think that a good point to bring up here is one that Dr. Greger addresses in another video. All fructose is not considered to be equal- Industrial fructose vs. fruit fructose are different birds. There have been different theories on this but it seems that the fiber within the fruit as well as the phytonutrients (maybe more important than the fiber) seems to blunt the diabetic response, if you will. Check out the video here, and remember to eat blueberries with your pancakes as Dr Greger says! (wink)
      If Fructose is Bad What about Fruit?

  • HemoDynamic, M.D.

    I’m really starting to look at NutritionFacts.org as the Discovery Channel for Nutrition!

    Sweeeet information! I’ll see your Granny Smith and raise you a Honey Crisp!!!

    • Leslie Stanick

      I love the image!!! Thanks for the visual joke!

  • Dave

    Ooops, I just at 5 bananas today.

  • JuliaKathleen

    I am so glad to hear that you will be addressing the effects of sugar in fruit. I have been really wanting some solid information on this. Thanks.

  • Veg-E

    I agree with this when it comes to refined processed sugars, but I can’t see this applying to whole fruits. There are people like Michael Arnstein who eat mostly fruit and are in great health. In fact Arnstein is breaking long distance running records living on a diet of mostly fruit and his blood work is perfect. How do you explain him and other thriving fruitarians? Like those eating 30 bananas a day and doing great also.

  • Fruit fly

    My metabolic specialist says that fruit is for kids, not adults. To use in moderation. Fruit juice is filled with sugar.

    • Mark

      Yes, Fruit juice is full of sugar, and fruit should be consumed in it’s whole form.

      Does your “Metabolic Specialist” have any hard evidence for this assertion, or is just silly fad BS he/she read somewhere? From the majority of “metabolic specialists” I’ve interacted with, many buy into all kinds of bunk and should not be used as a reference for much of anything.

  • Guest

    Does this only apply to ADDED fructose? I would think fructose in a fruit isn’t nearly as harmful since it comes with so many other nutrients.

  • Daniel Wagle

    I don’t eat as much fruit as a fruitarian, but I do eat usually about 3 bananas a day, as well as some other fruit, such as a kiwi or orange. Even so, my glucose level recently went down from the highest acceptable level of 99 down to 90. My LDL cholesterol is now 81- it is slowly going down. My triglycerides are 43 and my HDL is 77. I think fruit is not only not harmful, but positively beneficial, but fruit juice can be harmful (because of the lack of fiber). This study http://www.ncbi.nlm.nih.gov/pubmed/22882905 found a inverse relationship between whole fruits and the development of type 2 diabetes and a positive relationship between fruit juice and type 2 diabetes. From what I remember, Lustig stated that fruit wasn’t harmful, because it had fiber in it. I would certainly think processed sweets, such as cakes, donuts, cookies and pies would contribute to both type 2 diabetes and heart disease. I noticed last night reading labels, that some brownies for sale at the store had some trans fats in them. Just 1 or 2 tablespoons of ready to spread frosting has 1.5-2 grams of trans fat. I not only have cut out the meat, but I have really made an effort to drastically reduce my consumption of processed trans fats, as well as sweets. Everyone agrees that trans fats are especially harmful.

    • guest

      The concern is not having “normal fruit consumption.” The concern is that some vegans are consuming over 2000 calories a day of fruit, some over 3000 calories a day, and what are the long-term consequences of this? 3 bananas, no big deal. 15 bananas….? @0 dates? Sugar addiction? Maybe it is OK for someone exercises for 8 hours a day.

      • Daniel Wagle

        Here is an article http://well.blogs.nytimes.com/2013/07/31/making-the-case-for-eating-fruit/ which quotes David Ludwig as stating that the amount of fruit does not matter,
        “Dr. David Ludwig, the director of the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital, said that sugar consumed in fruit is not linked to any adverse health effects, no matter how much you eat. In a recent perspective piece in The Journal of the American Medical Association, he cited observational studies that showed that increased fruit consumption is tied to lower body weight and a lower risk of obesity-associated diseases.”
        It even quotes Robert Lustig as saying,
        “Another nutrition expert, Dr. Robert Lustig, a professor of pediatrics at the University of California, San Francisco, who has called sugar “toxic” at high doses and fructose the most “actionable” problem in our diet, is still a fan of fruit. “As far as I’m concerned, fiber is the reason to eat fruit,” since it promotes satiety and the slow release of sugar. He adds a third benefit from fiber: it changes our “intestinal flora,” or microbiome, by helping different species of healthy bacteria thrive.”
        This article also states something which has been stated on Nutritionfacts.org, which is,
        “Fiber provides “its greatest benefit when the cell walls that contain it remain intact,” he said. Sugars are effectively sequestered in the fruit’s cells, he explained, and it takes time for the digestive tract to break down those cells. The sugars therefore enter the bloodstream slowly, giving the liver more time to metabolize them. Four apples may contain the same amount of sugar as 24 ounces of soda, but the slow rate of absorption minimizes any surge in blood sugar.”

  • mdouble

    In the 1970’s I developed a condition called reactive hypoglycemia. Unlike base line low blood sugar, the reactive type involves the improper reaction to the consumption of sugar. The reason for this I learned was in part due to a fatty liver. The liver is an essential part of maintaining normal blood sugar levels. My physician at the time practised holistic medicine which included putting patients on a plant based diet. One of the side affects of this was to return my liver to normal function.

    Eventually I regained my health and have never returned to my old eating pattern. A part of my healing process involved learning about nutrition and how various food affects that body. From personal experience and lots of research I can say without exception that refined sugar, and high HFCS (High Fructose Corn Syrup) are 2 things which are highly dangerous and destructive in the human diet.

    Reading through the comments I noted some some confusion about fructose found in nature and those found in processed foods. It’s important to note that get get sugar from fruit requires that the food be digested first. This involves breaking down and separating the sugars from the fibre, as well as all the nutrients and micro-nutrients in the food. Refined sugar is absorbed quickly with little or no actual digestion involved causing the blood sugar to spike quickly, and challenging the body to quickly react to normalize the levels of blood sugar.

    Such a spike in blood sugar is less likely when eating fruit and vegetables because of the work involved to extract the sugars during digestion. In addition, it is my feeling that the body recognizes and distinguishes between sugar derived directly from food, and that which has been processed in advance.

    HFCS on the other hand does not exist in nature and so creates a whole series of other issues, one of which is development of a fatty liver. This is not simple conjecture of political spin, it is a product of extensive research. According to one of the leading researcher HFCS damages the liver in much the same way as does alcohol. This has to do with a very complicated process which is far to detailed to describe here.

    If you want more detailed information you should search for videos or articles on the subject. Several excellent videos were available for free on Youtube. The better ones contain very detailed and technically specific information about biochemistry from a world expert. However there are others which are more intended for the lay public.

    I would also pay close attention to Dr Gregors advice re HFCS.

    • http://twitter.com/MacSmiley MacSmiley

      Not defending HFCS: It’s problematic because of its ubiquity and amounts used. Yes, the free glucose/fructose in HFCS is not found in nature, but replacing it with sucrose (Mexican/Kosher Coke) is no improvement because of the swiftness of with which the body uncouples the disaccharide. Practically instantaneous.

      Lustig’s comparison of fructose to alcohol is one of his alarmist inaccuracies. Another inaccuracy is fructose’s contribution to blood sugar spikes. Fructose is the lowest substance on the glycemic index.

      In addition to Plant Positive’s videos about Lustig, you can find more of his science #FAIL at Carbsanity’s blog.

      http://carbsanity.blogspot.com/

      Just search the blog for his last name.

  • David Fell

    I have had 0 grams of added sugar in the last 8 months. This is one of the best decisions I have ever made! Together with the other changes my body has been transformed from sickness to success!

  • Charma1ne

    There are so many opinions and conflicting research that I find the more I read and learn the more eating what is good and healthy these days becomes one of the hardest things to do. Everything seemingly needs an ‘nth’ degree of control, and to the health conscious food and it’s many complexities is fast becoming an obsession. Sometimes there is just so much you can do with the knowledge you have and the time available. Personally we love fruit and vegetables alike and we do not eat meat. I would like the preparation of food and the consumption of it to be less fraught and stressful than it is becoming and more of a delight and a pleasure to share with friends and loved ones.

  • anthonyp

    Its amazing how if one just cuts out all processed food and allows natural, whole foods to provide natural sugars we would not have such epidemics. Thanks for your work Dr. G. Such an inspiration.

  • Guest

    With regards to the sugar content of dates, Dr. Greger posted a video (http://nutritionfacts.org/video/are-dates-good-for-you/) addressing the high sugar content (80% sugar by weight) and what we would PRESUME to be an adverse effect on blood sugar levels post-consumption. The conclusion given in the video is very hard to accept (believe?) and seems to contradict what would intuitively make sense…that given the exceedingly high sugar content of dates, there would most definitely be a a negative impact on blood sugar level after “stuffing oneself with the things”. Having a hard time reconciling this. Thoughts?

  • Guest
  • Guest

    Sorry about that, but I can’t seem to paste in the link to the video. Again…

    http://nutritionfacts.org/video/are-dates-good-for-you/

    Just do a search on “dates” and you’ll get the video titled, “Are Dates Good for You?”

  • econdemocracy

    Did two interesting (to me at least) calculations to get a clearer view. First, Dr. Greger cites 1776 as 4 pounds sugar per year. This sounded low enough that I guessed he meant that little *added* sugar per year, not total sugar, but to check up on this, calculated this way, to compare to bananas:

    4 pounds in grams (b/c 1776 4 pounds sugar per year) = 1814
    1814/365 = 4.9698630137 grams per day (just type any arithemetic or units convertion into Google search and it spits out the answer)

    Which rounds very very well to 5 grams of sugar per day.

    Also given that: medium banana: 14.4 grams sugar (includes skin but I imagine there is
    little sugar in the skin) (per http://www.calorieking.com/foods/calories-in-fresh-fruits-bananas-raw_f-ZmlkPTczMzI5.html )

    So that means that if the figure cited in the paper Dr. Greger quotes *includes* in-the-fruit sugar, then they ate the equivalent of only one-third of a banan per day and NO other sugar at all in 1776 (no other fruit with sugar, like apples etc)? That sounds too low
    they must be talking about ADDED sugar, right?

    eating the proverbial “Apple a day” would include 10.6 grams per day, more than TWICE the “5 grams per day” cited for 1776.

    So I’m pretty sure this means “grams of added sugar”…either that or they had less than a half apple a day (and no bananas or any other fruit) on average, which is conceivable, but certainly NOT what we condier healthy today (eating *more* than a half apple per day in terms of fruit consumption equivalent is recommended..and I say this as a person who doesn’t like fruit that much and prefers veggies..)

    Either way for all future videos being clear on “grams of sugar from all sources” versus “grams of added sugar, not counting those in fruit” would be helpful to clarify.

    • econdemocracy

      Second calculation was the quote by Zuppkko that: “The importance of bananas as a food crop in tropical areas cannot be
      underestimated. In Uganda, for example, annual consumption per capita was some 243 kg in 1996, and between 100 and 200 kg in Rwanda, Gabon and Cameroon. In these 4 countries, bananas account for between 12 percent and 27 percent of daily calorie intake of their populations.”

      Was scratching my head to make more sense of this in terms of fruit consumption again. “sfgate.com” says “avg” banana is 4ounces, the Calorieking says 4.2 ounces for “medium “banaa is including the peel…which might
      weigh more than 0.2 / 4 = 5% of the weight..but close enough so say “4oz” per medium banana.

      Say 150kg per year (middle of the 100 to 200 kg range for the latter two countries) and converg kg to grams and from annual to daily to get (150*1000)/365 which is 411 grams per day.

      google “411 grams in ounces” and google’s built in calculator spits out: 14.5 ounces (per day)

      14.5 ounces / 4ounces per med banana = 3.625 bananas per day..

      That is finally a figure I can comprehend (as opposed to kilograms per year).

      Sounds like a high but reasonable consumption level…

      But also wanted to know sugars: 3.625*(14.4 grams/med banana) = 52.2 grams of inside-the-banana sugars
      per day.

      Whether that’s optimal or even healthy is another question,
      but I think we can be pretty sure it’s *not* “very unhealthy” or they
      would have some diabetes problem in that country.

      Still, I noticed that the “30 bananas per day” philosophy is 827% of (or a 727%
      increase) over the “high-fruit consuming African countries” stats showing a bit over 3 and a half banans per day. It might be (probably is) healthier than the SAD, but…sounds extreme (also more than 4 or 5 in a half day and my mouth tastes too sweet, based on the very rare times I’ve used 4 bananas in a smoothie (just water and ground flax seed added, no other sweeteners)

      but now I’m gonna get the Wrath of the 30 Bananas a Day falling on me right? All I really wanted was to get, mostly a clearer picture of 1776 (see above comment this replies to) and sugars in whole foods versus added/refined sugars (and to get a handle on what those Uganda stats meant in “bananas per day” terms as supplemental info)

      • econdemocracy

        Haven’t used NF in many months…let’s see if I can do html like the charismatic Hemodynamics here?

        And not sure if I’m donig something wrong but why do I need to login with user name and pw at the top right of the website and then separately log in via disquis to comment? Or do I not have to do the former if I do the latter?

        • jj

          Why is there so much discussion about fruit when the video is about ADDED SUGAR?

          • jj

            Sorry was trying to make a general comment not reply to econdemocracy.

  • http://twitter.com/MacSmiley MacSmiley

    Fructose? I’m wondering how much protein you’re getting with that % of fruit in your diet. Typically, fruit has 1g per serving, many less than that.

    http://nutritionfacts.org/video/changing-protein-recommendations/

  • PJ Whiting

    I’m interested to hear the video too, I have recently started healthy eating and I must say i am so confused about fruit. When I started eating this way, I first had to decide what I was and wasnt going to eat. Paleo, vegan, it was all really confusing.
    Finally I made the decision that anything natural I would eat, anything that God gave us to eat basically. I am not a particularly religious person, but I am looking at food in a totally different way. I had a serious sugar addiction and had to kick that, the only way I could give up sugar was to eat sweet fruit, for the first few weeks I overate, I ate a full punnet of strawberries in one sitting and then felt so guilty, hardly daring to goggle how many calories was in a punnet of strawberries, then I had to check twice to make sure it was really only that amount.
    Over the weeks I have calmed down and now only eat fruit twice a day and a huge variety of all different fruits. I’m never hungry and have found a real love for fresh produce, fresh veges, huge salads, huge fruit salads. Nuts, almond milk, are all changes I am slowly making. I feel better, my health is improving, I am losing 1kg a week with no effort. I find it very hard to believe that we were given these beautiful fruits to eat but they would make us fat? Not sure that makes any sense. I am trying to eat balanced full healthy meals and I intend to keep on including as much fruit as I want.
    I’m also a little tired of the pesticide debate, people are okay about putting toxic ingredients that cant pronounce into their bodies but worry about what might be on their apples

    • Brux

      I can relate to when you say you had a serious sugar addiction. I do to. As a kind all the programming that went into hooking me on sugar and junk food worked pretty well. Anything with chocolate, sugar, bright colors, butter, etc, I loved. I have a soft drink with almost every meal. Oddly enough it was not until I passed my 40’s that I started having weight issues and BP. Fruit is hard to switch too because it is not as sweet, not as fatty and not as uniformly powerful sweet-wise to my body as all the sweet stuff I used to eat. I’ve done pretty well, and one thing I’ve noticed that has given me hope is that if you can switch in some good stuff, you crowd the bad stuff out, and eventually you start to lose the irrational hunger for all that junk. I get urges fairly often, but now I can actually look at ice cream and feel kind of sick, like I just could not eat that any longer. i am worried about pesticides as well, and getting enough. They say 6 servings… who can eat that much, or get that much good fruit … or even afford good fruit if you can get it. When a cup of blueberries here in the Bay Area can be $6. You can buy other stuff, but then you find half of it is bad, or underripe, or rotted, or tasteless. I am thinking of trying frozen fruit, but not sure if that counts really.

  • carter le grand

    I have so many dietary issues that I don’t know where to start….hiatal hernia, type 2 diabetes (due to losing half of my pancreas to remove a large cyst) gluten intolerance, reddened esophagus and a colostomy. I hear and read so many conflicting things that I don’t know what to believe. My VA nutritionist tells me one thing, and the diabetes nurse says the opposite. The doctor, of course prescribes pills. I flushed my metformin, lisinopril, and amlodipine down the toilet in lieu of a plant based diet. My high BP is down, but I still get blood glucose spikes after meals, even though I “graze” and get up at 3 AM to avoid a dip to 70 or lower in the morning. The “spikes” are more like nails as after a meal of 1/2 greens, 1/4 beans and 1/4 meat I go from 90 to 140 after 75 minutes. I’m told that this is TOO HIGH and that bad things will result…..any help?

    • carter le grand

      I forgot to add: I’m six feet even, 140 lbs of muscle and bone. I exercise twice daily after lunch and dinner, drink a pot of coffee and green tea a day. I take vitamin D and wheat grass and milk thistle, and put turmeric on everything. My refined sugar intake is low. I eat no junk food, wheat, restaurant food or milk.

      I do eat eggs and cheese. I have 2 rum drinks or light beer a day.

    • Thea

      carter le grand: I think the following book from Dr. Barnard is just for you! He did a study that showed that his diet is 3 times more effective at reversing diabetes than the ADA diet. I highly recommend the book, not only for the great info, but because it includes recipes too. That will help you get started on fixing your diabetes problem.
      http://www.amazon.com/Neal-Barnards-Program-Reversing-Diabetes/dp/1594868107/ref=sr_1_1_twi_1?ie=UTF8&qid=1425083858&sr=8-1&keywords=program+for+reversing+diabetes

      Good luck!

    • Brux

      I have enough trouble trying to figure out what the experts are saying any week, but I while back Dr. Gregor did a video that talked about how meat raises insulin levels too. You might consider cutting out that meat for a month and seeing if that makes any difference as an experiment. I am not recommending anything since I am not a doctor. For me, I find I have to test my own ideas and see if they work because the information even from the most well meaning doctors is conflicting.

  • jenne

    How many grams a day would be Ok for a healty balance?

    • Joseph Gonzales R.D.

      Guidelines vary. The World Health Organization recommends less than 5% of total calories (less than 25 grams of added sugars per day). The USDA recommendations vary based on age and sex. See if these suggestions help?

      Best regards,
      Joseph

      • jenne

        Thanks Joseph I don’t have any weight issues but do like to keep my sugar down – 25 grams is about what I shoot for if not less. i have just been cured from Hep C for its important for the live to keep sugar at a mimim. It has left me with Stage 4 crisshois but have no sides as a result ( yet ) My Dr has me on Xilfrman for HE – anywhere thats way off the discussion I do thank you for your reply

  • dogulas

    Are there any sources of added sugar that don’t contain fructose? Or contain less than table sugar? Any nearly pure glucose that isn’t expensive?

    • Joseph Gonzales R.D.

      Hey Douglas check out the “healthiest sweetener” video in the Doctor’s Note. Dates and molasses tend to rule!

  • Wade Patton

    If you have any doubts about the sugar problem (and causes) in America, see “Fed Up” (2014). It’s on Netflix. Just watched it. Horribly sad, but maybe will enlighten some of the massive masses.

    • Brux

      There are quite a few good documentaries on NetFlix related to health and nutrition. I am kind of surprised at that. Thank goodness because what I used to hear on the radio in the past decades is all gone, replace by corporate crap and nonsense. At least there is somewhere that some real facts can be heard. That said there are a few scams on the health industry as well. This dilemma seems to strike right at the heart of the way we run the country and the economy, on a kind of buyer beware basis, and if we did not have all the suckers we do to buy this poison, our economy would be dead.

      • Wade Patton

        I don’t want to dive into the political, but do believe that “our economy” can and will shift over to more healthful food products when it becomes apparent that a dying population (this is the big head-in-the-sand issue) costs the economy more than it can suck from those suffering from the current food products. How ridiculous is it that we INCREASED life expectancy during the Great Depression and are now experiencing a DECREASE in life expectancy-and teetering on the brink of animal-food-product superbug pandemic? I can’t fix all that. I can barely focus on me, and learning more and being a good example.

  • Brux

    Every day it just burns me up that hardworking good American citizens have been and being preyed on in this way by cheapening and then outright adulterating and poisoning the foods we eat while we are being brainwashed to think they are so good for us and our country and way of life is so great. What an evil scam, and why does it continue to go on and even get worse. The other day in the Safeway here in CA I saw a new product … chocolate covered Twinkies. Ugh!

  • Candice

    What about freshly squeezed sugar cane juice? As it is unrefined and so almost a whole food, surely it is not harmful in moderation?

    • Thea

      Candice, I would not consider “freshly squeezed sugar cane juice” to be a whole food or even almost a whole food – not any more than freshly squeezed orange juice. NutritionFacts has several videos on juices that might she light on the matter for you. There was some benefit to drinking very pulp-y juice. But is your freshly squeezed sugar cane juice akin to pulpy juice or more like clear juice?
      Try this one: http://nutritionfacts.org/video/if-fructose-is-bad-what-about-fruit/

      I think the key to your question is the last two words, “in moderation”. To, that I usually have two thoughts – a) what does the person think counts as ‘moderation’? and b) if ‘moderation’ amounts are based on some evidence that the amount truly is moderate for that substance, then no, it probably is not harmful. In other words, I would consider a teaspoon of a natural sweetener (any kind really) in a dish that serves say 4 to be very moderate. But I could have a lot more of another food – say and entire apple – and that would be moderate for that food. The problem with the word ‘moderation’ is that people often have wildly different understandings for what counts as moderate and usually no evidence to back up that belief.

      What do you think?