Sugarproof

Description

A leading childhood nutrition researcher and an experienced public health educator explain the hidden danger sugar poses to a child’s development and health and offer parents an essential 7- and 28-day “sugarproof” program.

Most of us know that sugar can wreak havoc on adult bodies, but few realize how uniquely harmful it is to the growing livers, hearts, and brains of children. And the damage can begin early in life. In his research on the effects of sugar on kids’ present and future health, USC Professor of Pediatrics and Program Director for Diabetes and Obesity at Children’s Hospital Los Angeles Michael Goran has found that too much sugar doesn’t just cause childhood obesity, it can cause health issues in kids who are not overweight too, including fatty liver disease, prediabetes, and elevated risk for eventual heart disease. And, it is a likely culprit in the behavioral, emotional, and learning problems that many children struggle with every day.

In a groundbreaking study, Goran’s team conducted a detailed analysis of the sugary products that kids love and found that these yogurts, cereals, sodas, and juices often had more sugar than advertised and also contained different types of sugar than were being disclosed. Today’s children are not just consuming more sugar than ever, but they are consuming sugars that are particularly harmful to them–and their parents don’t even know it.

The news is dire, but there is also plenty of hope. We can prevent, address, and even in many cases reverse the effects of too much sugar. In this guide to “Sugarproof” kids, Dr. Goran and co-author Dr. Emily Ventura, an expert in nutrition education and recipe development, bust myths about the various types of sugars and sweeteners, help families identify sneaky sources of sugar in their diets, and suggest realistic, family-based solutions to reduce sugar consumption and therefore protect kids. Their unique “Sugarproof” approach teaches parents to raise informed and empowered kids who can set their own healthy limits without feeling restricted. With a 7- and 28-day challenge to help families right-size sugar in their diets, along with more than 35 recipes all without added sugars, everyone can give their children a healthy new start to life.”Learn from one of the world’s leading experts on sugar and its impact on children from womb to tomb. This book blew my mind and underscores the importance for all of us to reduce sugar and starch intake to protect not only ourselves but our future generations.”
–Mark Hyman, MD, Head of Strategy and Innovation: Cleveland Clinic Center for Functional Medicine, #1 New York Times bestselling author of Food Fix: How to Save Our Health, Our Economy, Our Communities and Our Planet – One Bite at a Time


“Sugarproof really helps you to be smart and conscientious about sugar while also providing grace for some of the joys of being a kid” and/or “I was shocked when I was reading this. I thought I was fairly knowledgable on nutrition and what I was putting into my kids’ bodies. Really and truly, I cannot reccommend this book enough. It’s just a wealth of knowledge and a must-read for parents”
Nikki DeLoach – Actress and media Spokesperson
 
“Sugarproof is a game-changer. All parents need to read this book. Frankly, I think everyone should read this book because you need to understand the science of sugar and how we can get it out of our food supply. I think it’s going to change a lot of lives and it’s going to help a lot of kids and families”
Will Bulsiewicz, MD MSCI, New York Times bestselling author of Fiber Fueled

“This is a really important topic. What we’re feeding our children will affect not only how they feel, how they learn, and how they behave today, but also it affects their future, and it’s our job as parents to really look out for them and try to reduce sugar. Sugarproof gives us the tools to do that.”
Kelly Leveque; Holistic Nutritionist, Health Coach and author of “Body Love Every Day” series
“How and what we feed our children is of the utmost importance. In this digestible book, Emily and Michael deftly illuminate the nature of sugar in our world today, and what role it should play in a child’s diet — it is essential reading for parents, educators, and eaters alike.”
—Alice Waters, chef, author, and Founder of the Edible Schoolyard
 
“Every year obesity and diabetes rates hit new highs in America. Non-alcoholic fatty liver disease is now epidemic in America (and around the world), and the sugars we consume are the most likely cause of all of these. These sugars are hidden in virtually every processed food and constitute far and away our major dietary addiction. Even those of us who try to restrict our sugar consumption can be easily fooled by the sugars hidden in the foods we buy every day at the supermarkets. Families desperately need a guide like Sugarproof to help identify these hidden sugars in their diet and provide a thoughtful and workable guide on how to cut back to a reasonable and safe level.”
—Gary Taubes, author of The Case Against Sugar
 
“There is a huge gap in the practical issues that must be faced to tackle the added sugar epidemic in our country. Michael Goran is a leader laying out practical and meaningful strategies for parents and families that want to learn about the presence of sugar in our diets, the health effects, and clear guidelines on ways to reduce sugar intake.”
—Barry Popkin, Ph.D., W. R. Kenan, Jr. Distinguished Professor, School of Public Health, University of North Carolina; author of The World Is Fat
 
“Dr. Michael Goran is a thought leader in the field of childhood nutrition. As a researcher and a parent, I can attest to the need for his new book Sugarproof. We are facing a silent crisis of obesity among our youth, and it is often the case that parents don’t realize the damage that poor nutrition has inflicted on their child until it is too late. With our overly sugared food supply, parents need the resources and knowledge to help their children get on the right track to better health. Dr. Goran gives them that in Sugarproof.“
—Nicole Avena, Ph.D., author of What to Feed Your Baby and Toddler
 
“This book will help parents, teachers, and nutrition educators identify ways that they can help create the change we need to see in our food, food products, marketing, and communities to put a serious dent in the public health crisis that childhood obesity represents today and in the future. I am thrilled to see this work and believe strongly that it will be a game changer to move us in a different direction–from information to action.”
—Ashley Koff, RD, award-winning nutrition expert and CEO, The Better Nutrition Program
 
“There are many health advocates pointing out the dangers of sugar use by infants and children. But none of this advocacy has been as practical and courageous as that of Michael I. Goran, Ph.D. By analyzing the types and amounts of sugar actually present in the foods that our children are exposed to, he has provided us with shocking and invaluable insight. Dr. Goran’s Sugarproof translates his study findings into concrete suggestions for the protective action that today’s parents, teachers, and health professionals desperately need. I look forward to making this book required reading in all of my trainings and to promoting it in whatever other ways I can.”
—Julia Ross, author of The Diet Cure, The Mood Cure, and The Craving Cure
 
“Dr. Michael Goran trained as a biochemist and started out his research journey as a human physiologist. But as he realized the primacy of diet in chronic disease, he has morphed into a pediatric nutrition research powerhouse. He has helped elucidate how dietary sugar can be uniquely problematic even for babies, and how it can derail the process of healthy growth and development. His work has provided insightful understandings on how to translate research findings into effective ways for reducing sugar consumption in childhood.”
—Robert Lustig, MD, MSL, Emeritus Professor of Pediatrics, UCSF, and author of Fat Chance and The Hacking of the American MindMichael I. Goran, PhD, is one of the world’s most widely recognized experts in childhood nutrition and obesity research, with more than 30 years of experience as a researcher, mentor, and educator. He is a Professor of Pediatrics at the University of Southern California, Keck School of Medicine, Co-Director of the USC Diabetes and Obesity Research Institute and leads the Program in Diabetes and Obesity at Children’s Hospital Los Angeles. He holds the Dr. Robert C and Veronica Atkins Endowed Chair in Childhood Obesity and Diabetes. Michael is a native of Glasgow, Scotland, and received his Ph.D. from the University of Manchester, UK.  Emily E. Ventura, PhD, MPH, is an experienced nutrition educator, public health advocate, writer, and cook. She completed her Master’s in Public Health and PhD in Health Behavior Research at the University of Southern California. She was selected as a Fulbright Scholar to teach Public Health Nutrition in Italy and is a mother to two young boys.

Chapter One

Growing Up Sweet

Can Turn Sour:

All Our Kids Are at Risk

From the outside, Melissa looked healthy. She was a slender, athletic thirteen-year-old who loved playing basketball and soccer. Yet something was clearly wrong. Despite her long afternoons of sports practice, Melissa had trouble falling asleep. During the night, she woke up multiple times, and because of this, she’d become moody and dark circles emerged under her eyes. On top of everything else, Melissa felt constantly bloated and had frequent stomach cramps.

Under her normal-kid exterior, Melissa’s body was silently developing the signs of chronic disease. And behind this disturbing transformation stood one clear factor: the sugar in her diet. Melissa’s sugar habits over the course of the day had gradually worked up to a breaking point. She had juice most mornings at breakfast, a cereal bar on school days for a snack, tea sweetened with sugar most evenings, ice cream every other day for dessert at home, and the occasional candy bar from the convenience store down the street from her house when out with friends. Also, Melissa was chewing “sugar-free” Trident gum every day, which is sweetened with a variety of sugar alcohols and other sweeteners.

Melissa doesn’t fit what we think of as the profile of a kid on the verge of serious health problems. Melissa wasn’t overweight; she wasn’t drinking soda; she was physically active; her parents tried to emphasize healthy eating habits. But sugar is now so pervasive, and food marketing so insidious, that during the course of her busy days, Melissa ended up consuming unsafe quantities of not just sugar but also other sweeteners without her parents’ full awareness. Because Melissa’s parents eventually realized how much sugar Melissa was consuming, they were able to help their daughter reshape her eating habits, and Melissa started to feel energetic and happy again.

Melissa could easily be any child growing up in the United States today. She could be a child in one of our families, or a child in yours. That’s exactly the point. No matter whether they are slender or overweight, whether they are active or sedentary, whether they live in a food desert or in a farming community, whether they live in suburbs or cities, all our kids are at risk because they are living their lives immersed in sugar. They’re at risk for the familiar downsides of sugar-the energy rushes and the crashes. But with our combined fifty years of experience, we know both from our research and from our professional interactions with families that children are at risk for other dangers, too. As a parent, you might attribute symptoms like mood swings, poor sleep, fatigue, difficulty concentrating, or other health issues to stress, hormones, a growth spurt, or an underlying disease. The reality is that all of these problems, whether they seem minor or major, can be connected to too much sugar. Sugar could be causing much more damage to your child’s body than you imagined. Compelling new research has shown us that sugar is more dangerous than anyone ever knew, affecting nearly every part of a child’s developing body.

The Perfect Sugar Storm

Marco is another kid who seemed pretty healthy from the outside. At age seventeen, he was a big guy. He was overweight, but he was also strong and athletic-looking. And in fact, Marco spent several hours each day playing ball after school and didn’t have any other complaints about his health. But underneath his sporty exterior, our evaluation led to a disturbing diagnosis-Marco was very sick.

Because he was overweight, Marco’s pediatrician referred him to one of our clinical research studies. Our initial dietary intake uncovered some alarming news. Marco and his family thought he was making reasonable food choices for an active teenager, but in fact he was drinking juice, soda, and a couple of sports drinks every day, which comes to a whopping 100 grams of sugar. That’s around 25 teaspoons daily-more than three times the maximum amount we recommend for boys Marco’s age. Without realizing it, Marco was delivering a very dangerous sugar load to his liver, more than his body could handle. Part of our study was focused on studying the effects of sugars and excess body weight on liver health in children, so Marco had an MRI of his liver. Marco, his family, and his pediatrician were all stunned to hear the results: Marco was suffering from an extreme case of fatty liver disease, with measurable signs of damage to his liver. If Marco didn’t make changes soon, he could eventually find himself in need of a liver transplant.

Fatty liver disease used to be a problem reserved for adult alcoholics. These days, we’re no longer surprised when we discover that kids in our clinic are in advanced stages of liver trouble. Not to mention kids with type 2 diabetes or other metabolic disorders. Why? All of us, adults included, are susceptible to the harmful effects from too much sugar. But research shows that children in particular are at increased risk. This risk is caused by three critical conditions: kids’ inborn preference for sweet flavors; today’s high-sugar food environment; and the unique vulnerability of kids’ developing bodies to the effects of too much sugar. These three conditions have come together to create a perfect sugar storm for our kids.

Born This Way

How long has it been since you had a package of Pixy Stix? Pop Rocks? Grape Bubble Yum? If you loved these sweets as a kid and have tried them as an adult, you probably wondered how you could ever have enjoyed dumping so much sugar straight into your mouth. But you probably did love it when you were a kid. Here’s why: Kids have a stronger built-in preference for sweet flavors compared to adults. They are more attracted to both real sugar and low-calorie sweeteners. Given the choice, kids will typically select the sweeter option, and then want more of it. Even amateur scientists have documented the phenomenon. My (Michael’s) daughter’s elementary school science class performed a simple experiment, asking both kids and teachers to taste five different lemonades of varied sweetness. The younger kids preferred the sweetest version and the teenage kids and adults preferred the less sweet versions.

As your kids have probably informed you, their taste buds really are different from yours. Their inborn love of sweet tastes makes evolutionary sense. It ensures that infants will like breast milk, which is sweet. As they start to wean, their preference for sweets helps them avoid bitter-tasting foods that could harm them. A child’s love of sweets is not a moral flaw. Kids who clamor for Pixy Stix and Pop Rocks are just being kids. But as you’re about to see, this natural attraction to sweetness makes kids highly vulnerable within our modern food environment.

Our Kids Live in a Sugar-Saturated Environment

Alyssa lives in the heart of South Los Angeles and within a food desert-a neighborhood with few options for healthy, fresh food. Alyssa could easily walk to convenience stores and fast-food restaurants from her home and school, but if her family wants to shop at a grocery store that offers produce, they would have to drive twenty minutes or take a long bus ride. Because Alyssa was concerned about her family’s history of diabetes, she agreed to participate in our sixteen-week research study, which was designed to help teens eat less sugar. Alyssa shared with us a view of her neighborhood and the impact it had on her food choices: “Right across the street I have the doughnut shop, I have the gas station, the liquor store, and then one block over you have the Burger King, Subway, and an other gas station. Another block over you have your Taco Bell/Pizza Hut, and McDonald’s. So say . . . I was hungry, and I had about $5 in my pocket, I could either go this way and indulge, and go that way and indulge. Or even go right across the street and get chips and a soda. So either way, it’s bad.”

Alyssa’s situation is extreme, but it’s not all that unusual-about 20 percent of all US households are in food deserts. And in some ways, all of us have experiences like hers, whether we live in a true food desert or not. Think about the last time you were in a restaurant, at an airport, on the road, or at a party. You probably had some options for healthy eating, but it’s likely that those options were far outnumbered by the junk. Sweets especially tend to dominate: the sweet coffee drinks, sauces, dressings, pastries, and desserts. And as you’ll see in a moment, even savory foods often contain sugar as well. What has brought us to this point? Why can’t Alyssa escape sugar even when she tries? Why can’t you and your kids?

We have some answers to these questions. Five environmental elements contribute to the sugar-loaded food environment in which we now live. Think of them as nutritional weather conditions that children and families have to navigate every day, each contributing to a downpour of sugar (Figure 1):

Figure 1: The Five Environmental Elements Contributing to the Perfect Sugar Storm

One evening when my (Michael’s) daughter was nine, I picked her up from ballet, and she made a special request for turkey dogs for dinner. We stopped at the grocery store, and I ended up doing a bit of research looking for the best choice of hot dog buns. While I checked the nutrition labels, my daughter was rolling her eyes. As the child of a nutrition scientist, she had long ago become used to these types of thorough examinations. As I looked for a decent percentage of whole grains and limited preservatives, I couldn’t help but notice that every package on the shelf featured some kind of added sugar. Most of the time, it was listed as the second or third ingredient. The buns that were lowest in sugar had a minimum of 3 or 4 grams of sugar (that’s 1 teaspoon) in each bun, so I bought a package of those.

Of course, 1 teaspoon of sugar in a hot dog bun is not really such a big deal. But I was surprised that I couldn’t find at least one option without added sugar. And the surprises didn’t end there. When we sat down to dinner, none of us would have known the buns contained any sugar. They didn’t taste sweet. In fact, they didn’t taste very good at all. No one liked them, and we ended up eating the hot dogs without the buns. I couldn’t help but wonder: What would the buns have tasted like without any sugar added? Of course, as a nutrition scientist, I know that food companies often add sweeteners to mask the taste of other chemicals and preservatives and to enhance palatability. The result can be more of a neutralizing effect than a sweet flavor.

You might fondly recall childhood cultural touchstones like a cone from the ice cream truck, a dripping Popsicle at the swimming pool, or a cookie after school. I grew up in Scotland in the 1960s and ’70s, and I have happy memories of the “lemonade van,” which came around on Saturday mornings to sell sodas. On occasion, my parents would buy a bottle for the family to share at dinner. For me, it’s a happy memory built around ritual, family, and food. We enjoyed it and it is-to this day-a fond memory of childhood. When I recently asked my eighty-four-year-old mother about this, she indicated that there was never any concern about this affecting our health. Soda was a treat to be enjoyed together as a family.

Today, sugar is everywhere. It’s no longer a treat or saved for a big or special occasion. It’s our baseline, our environment, and has become an everyday staple. We’ve normalized the nearly constant consumption of sugar in childhood. It can seem that everywhere a kid turns, there stands a well-meaning adult offering something temptingly sweet: as an after-school snack, during sports practices, at playdates, or at a grandparent’s house. Holidays, traditionally a time to enjoy sweets, have gone supersized. One parent lamented, “It’s as if Halloween through Easter has become a six-month-long dessert buffet.”

The historical view can provide perspective. During the American colonial period, the amount of sugar consumed by the average person in 1750 was just 4 pounds per year, which is just over 1 teaspoon per day. By 2000, sugar consumption peaked at 150 pounds per year-or a whopping 45 teaspoons per day for the average American. Imagine a 2-pound bag of sugar. In 1750, the average person was consuming two of those bags in a year. By 2000, this increased to one and half bags of sugar each week. The United States is now the world’s largest per capita consumer of sugar. If you stacked all the sugar as cubes from one day of sugar consumption in the United States, it would tower halfway to the moon.

As my encounter with the hot-dog buns shows, it’s not just that sugar is offered to kids more often (more about that soon) but that it’s hiding. Even when you’re looking for it, sugar can be hard to spot. Of course it’s in cookies, cakes, and ice cream, but it’s also in places parents think of as “safe”: hot dog buns, bread, granola bars, yogurt, milk, salty snacks, sausages, frozen meals, pasta sauce, salad dressing, and more. Again, a staggering 70 percent of all packaged foods at the grocery store contain some kind of added sugar-for snack foods, the number rises to 80 percent. Sometimes it’s easy to read an ingredient list and identify the sugar. When you get in the habit of reading labels, you’ll notice how often sugar appears as a first, second, or third ingredient. But there are also whole categories of sugar that are disguised with healthy-sounding names, such as organic brown rice syrup or fruit juice concentrate. And that doesn’t even take into account artificial sweeteners like the designer chemicals aspartame, sucralose, and AceK, or all-natural sweeteners like stevia and monk fruit. They may not have the calories, but they can still cause problems for your child’s health. In the next chapter, we’ll help you identify these hidden forms of sugar so that you can make informed choices for your family. For now, it’s enough to recognize that your children are probably consuming vastly more sugar than you did as a kid.

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