Sugar: A Closer Lookby Elizabeth J. Hall

What is Sugar?

Sugar is an edible crystalline substance. It is naturally produced from sugar cane or sugar beets. Scientifically sugar refers to any mono or disaccharide. Remember that Mono = one; Di = two; Saccharide = sugar. When looking at a list of ingredients any ingredient ending in “ose” denotes a sugar. (i.e. glucose, fructose, galactose, and maltose are all forms of sugars.) This article primarily deals with sucrose and fructose corn syrup.

How Much Sugar Are We Eating?

The average U.S. consumption is 147 pounds of sugar per person each year. This translates into 46 teaspoons a day! Sugar consumption has increased by 25 pounds annually since 1970. Many refined sugars are “hidden” in processed foods Twenty per cent of our average daily calories come from refined sugars. Most hidden sugars consumed in the U.S. are found in soft drinks or soda and boxed cereal. The caffeine and phosphates in soda pop are also health risks.

12 oz. soda pop contains 7-12 teaspoons of sugar. Candy bars contain between 5-10 teaspoons of

sugar. Milk shakes have up to 24 teaspoons of sugar. 1 piece of cheesecake has about 24 teaspoons of

sugar. A glazed doughnut has 4-6 teaspoons of sugar. 1 scoop of (without candy added) ice cream has

about 5 teaspoons of sugar. Some cereals contain 3-4 teaspoons per 1 ounce

serving. 1 Tablespoon of jelly has 3 teaspoons of sugar. 1 serving of canned fruit in light syrup has 8

teaspoons per 1/2 cup.

Is Sugar Consumption Really a Problem?

“The free use of sugar in any form tends to clog the system, and is not infrequently a cause of disease. The free use of sugar means an excessive amount of sugar or sugar frequently used in the diet.” Counsels on Diets and Food p. 196 (italics mine)

What Are the Risks of Eating Refined Sugar?

Excessive insulin production. Refined sugar puts an abundance of sugar into the bloodstream at one time. The pancreas overproduces insulin to reduce the blood sugar level quickly. To start with, an individual may feel very energetic but soon his blood sugar level drops too low and they feel tired and fatigued, which makes them crave more sugar. High insulin levels are undesirable, even without diabetes being present, because they

increase the risk of heart disease and hypertension, encourage inflammation, and compromise fat burning processes. Excess insulin also causes one’s body to become depleted in calcium, magnesium, and chromium if sugar and sweets are consistently indulged.

Sugar and cognitive performance. Unfortunately, sudden rises and dips in blood sugar decrease mental performance. It is therefore very unwise to eat sugar or drink a sugary drink on an empty stomach.

Sugar and weight gain. The body metabolizes sugar best in the morning. Researchers from Cornell University discovered that children who drank more than 12 ounces of sweetened drinks gained significantly more weight than children who drank less than six ounces a day. Sudden surges of insulin could contribute to this, because excess insulin promotes fat synthesis. Also, both animals and people consumed more calories when they consumed a high sugar diet.

Dr. C.P. Richter is well-known for his cafeteria experiments. He showed that rodents will usually select a healthy, balanced diet by carefully selecting the appropriate food to eat and maintaining a normal weight. However, other researchers showed that when a 10 percent sugar solution was hung in one corner of the cage, the rodents gradually came to prefer it to the exclusion of the healthier chow. Ultimately, the rodents literally drank themselves to death.

Obesity. Excessive use of sugar may lead to obesity. Other tudies show that rodents who drank a sugar solution with standard chow consumed more calories than rodents who just consumed standard chow. In addition, the sugar-drinking rats had elevated serum levels of free fatty acids, triglycerides and cholesterol. The researchers concluded, by measuring hormones involved in appetite control, that the consumption of glucose, sucrose or fructose solution results in caloric over-consumption and body weight gain through activation of hunger signals and depression of satiety signals as well as activation of reward components.

Here’s another way the excessive use of refined sugars encourages obesity. It does not satisfy hunger and so may lead the person to overeat. Dr. Andrews of Monash University found that after eating sugar, appetite-suppressing cells are attacked by free radicals and that degeneration is more significant following meals rich in refined carbohydrates and sugars. When the stomach is empty, it triggers the ghrelin hormone that notifies the brain that we are hungry. When we are full, a set of neurons in the hypothalamus that help to control appetite, known as POMC's, are activated. However, free radicals created naturally in the body attack the POMC neurons. This process causes the neurons to eventually degenerate, thereby compromising our judgment as to when our hunger is satisfied

Especially troublesome is the combination of sugar and fat. Any diet that is high in fat and in sugar actually switches on genes that ultimately cause our bodies

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to store too much fat. Scientists show, via animal studies, that foods high in fat and sugar stimulate a known opioid receptor, called the kappa opioid receptor, which plays a role in fat metabolism. When this receptor is stimulated, it causes our bodies to store more fat than our bodies would do otherwise.

Sugar and diabetes. Researchers from Boston University's Slone Epidemiology Center found that African American women who consumed two or more soft drinks a day had a 24 percent increase in incidence of diabetes relative to women who drank less than one soft drink per month. A similar association was also observed for sweetened fruit drinks, with a 31 percent increase observed for two or more servings per day relative to less than one per month. However, to say that too much sugar always causes diabetes is not accurate. A more accurate statement would be frequent, long-term consumption of sugar is associated with an increased or magnified risk for developing diabetes.

However, consumption of excess sugar accelerate diabetic complications. For example, advanced glycation end products (AGEs) form when sugar is nonenzymatically linked to proteins. When eaten, AGEs induce cross-linking of the glycated proteins in the blood and body tissues. Dietary AGEs can react with tissue proteins to form substances that reduce tissue elasticity and impede cellular function. AGEs have been identified as a pathogenic mechanism in kidney and blood vessel damage so common in diabetic individuals. Diabetes is associated with significant impairment in AGE excretion.

Sugar and cardiovascular disease. Consumption of excess sugar over a period may contribute to cardiovascular disease and hypertension, especially in carbohydrate-sensitive individuals. A recent report from the Nurses’ Health Study showed that women who consumed diets with a high glycemic load (increased blood glucose elevation often associated with intake of sweets or highly processed starches, sweets) had an increased CHD risk. Those in the highest quintile had a >2-fold risk during 10 years of follow-up.

Sugar and lipids. Several studies have shown an inverse association between dietary sucrose and high-density lipoprotein (HDL) cholesterol. One study showed a consistent inverse association between increased dietary sucrose intake and HDL cholesterol concentrations, in both cross-sectional and longitudinal analyses in blacks and whites, in both men and women, and after adjustment for other confounding factors.

Diets high in sucrose (i.e. >20% of energy) are associated with an elevation of plasma triglyceride concentrations. This increase is due to both increased hepatic secretion of triglycerides and impaired clearance of very-low-density lipoproteins. It should be noted that triglyceride response to dietary sugar may vary, however, according to the amount of sugar and the presence of other nutrients.

Sugar consumption immediately impairs the ability of the blood vessels to dilate. A high-fat, refined carbohydrate diet also impairs the ability of the blood vessels to dilate (endothelial dysfunction). This effect is temporary if a person exercises before the sugar consumption. Be wary of high sugar, high fat combinations such as ice cream.

As previously mentioned, frequent consumption of sugar or soft drinks produces sudden surges of insulin, which promote atherosclerosis and contribute to diabetes, cardiovascular disease, and hypertension. Animal studies also indicate that diets high in sugar accelerate dysfunction in the ability of the ventricles to contract and mortality in hypertension compared to either a low-carbohydrate/high-fat or high-starch diet.

In 2009 the America Heart Associate recommended that women limit their intake of sugar to 6 teaspoons of sugar a day and men limit theirs to 9 teaspoons a day. The average American is consuming more than 20 teaspoons of sugar each day. The average 12 oz soda contains about the equivalent 10 tsps of sugar (Assuming a person drink one soda a day, 365 days a year, he would consume 3650 tsps or approximately 32 lbs of sugar (113.4 tsps/lb) just in terms of soda. When other sources of sugar is considered, one hundred and fifty-six pounds each year on a per capita basis,

Sugar increases oxidative stress. Sugar depletes antioxidants and even a short-term consumption of a high sugar diet increases oxidative stress. Oxidative stress occurs in tissues when the antioxidant defenses are overwhelmed and free radicals accumulate in excess. Animal studies show that even the short-term consumption of a high sucrose diet decreases vitamins and important antioxidant enzymes in the body and increases oxidative stress in the plasma, heart, thymus, liver, and pancreas. It also reduces carotenoids in the plasma.

Sugar and malnutrition. Most sugar calories decrease carotenoids and are “empty” of nutrients, vitamins and minerals. In overeating the body may actually be starved for nutrition. In addition, consumption of high-sugar foods often replaces the eating of healthy foods. Even in overeating sweets and fatty foods, the body may actually be starved for good nutrition. Additionally, excessive sugar consumption increases the loss of magnesium and chromium from the body. These two minerals improve the ability of the body to respond to insulin; consequently a deficiency of the two can contribute to insulin resistance. This, this in return, reduces the risk for developing metabolic syndrome and type 2 diabetes. Over-consumption of sugar also causes the body to use up its supplies of calcium, potassium, zinc and thiamin.

Tooth decay. From the inside out sugar slows the circulation of blood inside the tooth, and the bacteria outside feed upon the sugary foods and produce acidic substances that attack the tooth enamel and cause cavities. Demineralization of the tooth when a person

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snacks in between meals is also a factor in the promotion of tooth decay.

Lower pain threshold. A person on a diet high in refined sugars may feel any type of physical pain sooner than someone on a low-refined-sugar diet. Excessive sugar consumption promotes inflammatory problems.

Refined sugars decrease the production and activity (phagocytosis = cell eating) of the white blood cells (WBCs, neutrophils, precisely). See the following chart.

Sugar Weakens WBCs Ability to Destroy Bacteria:

Teaspoons of sugar Number of bacteria destroyed

Sugar and the brain. Sugar consumption deleteriously affects the brain. For example, a high-sugar, high-fat diet decreases BDNF, a natural fertilizer for the synapses. New research in a genetic mouse model of Alzheimer’s disease suggests that drinking an excess of sugary beverages like soda may increase the risk of Alzheimer’s disease. When the mice were given a diet consisting of 10% sugar water they experienced a 17% increase for developing Alzheimer’s compared to the controls. When tested for memory skill and brain composition, the sugar-fed mice did worse on learning and memory retention. Their brains showed over twice as many amyloid plaque deposits (a marker for Alzheimer's disease) as the controls. Amyloid plaque consists of tangles of amyloid protein in the nervous tissue and is a pathological marker of Alzheimer's disease. Sucrose-induced obesity also impairs High-level visual processing (ie. new object recognition) in young rats.

Sugar is a substance that releases opioids and dopamine in the brain and thus might be expected to have addictive potential. Swedish researchers found that consumption of sweets releases opiates (more precisely, releases endogenous opioids), which stimulate the appetite for more sugar. Animal studies show that sugar can be addictive. A Princeton University scientist found out that rats given sugar demonstrated two out of the three criteria for addiction. According to Bart Hoebel, he and his associates have demonstrated a behavioral pattern of increased intake and, upon cessation, signs of withdrawal. His current experiments have captured craving and relapse to complete the picture.

For example, when these rodents were denied sugar for a prolonged period, they worked harder to get it when it was reintroduced to them. They consumed more sugar than they ever had before, suggesting craving and relapse behavior. The rats drank more alcohol than normal after their sugar supply was cut off, showing that the

bingeing behavior had forged changes in brain function. These physical responses served as "gateways" to other paths of destructive behavior, such as increased alcohol intake as I just mentioned. But it was worse than that: after receiving a dose of amphetamine normally so minimal that it usually has no effect, the rats became significantly hyperactive. The increased sensitivity to the psychostimulant is a long-lasting brain effect that can also be a component of addiction.

Hoebel has demonstrate that rats eating large amounts of sugar when hungry, undergo neurochemical changes in the brain that appear to mimic those produced by substances of abuse, including cocaine, morphine and nicotine. Sugar also induces behavioral changes, too. According to Hoebel, “In certain models, sugar-bingeing causes long-lasting effects in the brain and increases the inclination to take other drugs of abuse, such as alcohol. When hungry rats drink a sugar solution, [a] chemical known as dopamine is released in a region of the brain known as the nucleus accumbens, an area in the brain that deals with motivation. Repeated stimulation of these area[s] by a drug of choice contributes to addiction.’”

The article continues, “Hungry rats that binge on sugar provoke a surge of dopamine in their brains. After a month, the structure of the brains of these rats adapts to increased dopamine levels, showing fewer of a certain type of dopamine receptors than they used to have and more opioid receptors. These dopamine and opioid systems are involved in motivation and reward—systems that control wanting and liking something. Similar changes also are seen in the brains of rats on cocaine and heroin,” but more research is needed to understand the implications for people. Other research provides links between the traditionally defined substance-use disorders, such as drug addiction, and the development of abnormal desires for natural substances.”

Please note other researchers have discovered it is the binges of sugar or certain fats that can release excessive dopamine, which causes compensatory changes that are comparable to the effects of drug abuse. Another point: excessive sugar intake not only increases dopamine in the nucleus accumbens, but it also eliminates the satiety response from acetylcholine. Among its other functions, acetylcholine is a neurotransmitter that promotes satiety. In this case, satiety is the sense of satisfaction we get from eating.

We should also mention that sugar increases serotonin in the hippocampus, which is involved in mood regulation. Serotonin, you remember, is a neurotransmitter that exerts natural anti-depressant effects. It might just be that those individuals who are addicted to sugar are trying to increase their serotonin and norepinephrine. We also know that serotonin depletion increases sugar seeking and consumption in animals.

Researcher BA Gosnell summarized it this way. “A number of studies have indicated a relationship between the intake of palatable foods or fluids and drug self-

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administration.” It reminds me of an observation that Ellen White made in the early 1900’s.

“Often intemperance begins in the home. By the use of rich, unhealthful food the digestive organs are weakened, and a desire is created for food that is still more stimulating. Thus the appetite is educated to crave continually something stronger. The demand for stimulants becomes more frequent and more difficult to resist. The system becomes more or less filled with poison, and the more debilitated it becomes, the greater is the desire for these things. One step in the wrong direction prepares the way for another. Many who would not be guilty of placing on their table wine or liquor of any kind will load their table with food, which creates such a thirst for strong drink that to resist the temptation is almost impossible. Wrong habits of eating and drinking destroy the health and prepare the way for drunkenness. {MH 334.1}

“It must be kept before the people that the right balance of the mental and moral powers depends in a great degree on the right condition of the physical system. All narcotics and unnatural stimulants that enfeeble and degrade the physical nature tend to lower the tone of the intellect and morals. Intemperance lies at the foundation of the moral depravity of the world. By the indulgence of perverted appetite, man loses his power to resist temptation.” {MH 335.1}

Soft drinks

The Framingham Heart Study, in a study of over 6000 middle-aged women and after adjusting for other risk factors, showed that 717 of 4033 participants (17.8%) consuming < 1 drink/day and 433 of 2006 persons (21.6%) consuming one or more soft drink/day developed metabolic syndrome.

Other researchers also observed that compared to participants who drank less than one soft drink daily, those who drank one or more soft drinks a day had a:

31 percent greater risk of developing new-onset obesity (defined as a body mass index [BMI] of 30 kilograms/meter2 or more);

30 percent increased risk of developing increased waist circumference;

25 percent increased risk of developing high blood triglycerides or high fasting blood glucose;

32 percent higher risk of having low HDL levels;

trend toward an increased risk of developing high blood pressure that was not statistically significant.

Soft drinks contribute to enamel demineralization in the teeth. Frequent consumption of soft drinks also increases uric acid. Serum uric acid levels increase with increasing sugar-sweetened soft drink intake. Elevated uric acid is associated with gout, hypertension, cognitive decline, kidney stones, and chronic kidney disease.

Consuming one soft drink a day can eventually cause kidney damage by causing the glomeruli to leak protein. Animal studies indicate that elevated uric acid can lead to endothelial dysfunction, a precursor to both coronary artery disease and hypertension. Soft drinks contain phosphoric acid, which causes the body to lose calcium. Researchers have discovered that consumption of sugary drinks, whether from consumption of glucose, sucrose or fructose solutions, leads to an over-consumption of calories and body weight gain by three mechanisms: first, through activation of hunger signals; second through depression of satiety signals, and third by activation of reward components in the brain as previously mentioned.

Better Alternatives

What About Stevia?

Extracted from the stevia plant. FDA approved as a dietary supplement that has no

after taste or side effects and is 200 to 300 times sweeter than sucrose.

Some of stevia’s components possess anti-hyperglycemic, anti-hypertensive, anti-inflammatory, anti-tumor, anti-diarrheal, diuretic, and immunomodulatory actions. Stevioside and steviol stimulate insulin secretion via a direct action on beta cells and therefore can help to lower elevated blood sugar.

Almost calorie free – depends on the base. Unlike sugar it does not trigger high blood glucose. No abnormalities in weight change, food intake, cell

or membrane characteristics, no enzyme and substrate utilization, or chromosome abnormalities. No cancer or birth defects.

Therapeutic Value of Honey Honey contains antioxidants, 25 oligosaccharides, and anti-viral and anti-inflammatory properties. It helps to protect the gastric mucosa in the stomach. Iran researchers found that honey ameliorates cardiovascular risk factors in both healthy individuals and in patients with elevated risk factors. In this particular study, there were 55 patients, overweight or obese, who were randomly recruited into the study and assigned into two groups: a control group (17 subjects) and an experimental group. Patients in the control group received 70 grams of sucrose daily for a maximum of 30 days and patients in the experimental group received 70 grams (about 2 and ½ ounces) of natural honey for the same period. Results showed that honey caused a mild reduction in body weight (1.3%) and body fat (1.1%). Honey reduced total cholesterol by 3%, the bad cholesterol LDL by 5.8%, and triglycerol by 11%. It also reduced fasting blood glucose by 4.2%, and the inflammatory marker C Reactive Protein by 3.2%, and increased HDL (3.3%) in subjects with normal values, while in patients with elevated variables, honey caused reduction in total cholesterol by 3.3%, LDL-C by 4.3%, triglycerol by 19%, and C-Reactive Protein by 3.3% than did the control group who consumed the equivalent amount of sucrose.

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Research has also indicated that the topical application of honey to a wound exerts anti-inflammatory activity, antibacterial activity, and stimulates immune responses within a wound. This includes wound healing in burns, ulcers, and other cutaneous wounds. Honey might also inhibit H. Pylori activity in the stomach.

Researchers at Pennsylvania State University studied 100 children who had nocturnal coughing and sleep difficulty due to an upper respiratory tract infection. They divided into three groups: those who received no treatment, those who received the cough medicine, honey-flavored dextromethorphan (DM), and those who received buckwheat honey. The researchers observed significant differences in symptom improvement, with honey consistently scoring the best and no treatment scoring the worst.

This reminds me of a quote from E.G. White. “[Here is] the remedy I use when suffering from difficulties with my throat. I take a glass of boiled honey, and into this I put a few drops of eucalyptus oil, stirring it in well. When the cough comes on, I take a teaspoonful of this mixture, and relief comes almost immediately. I have always used this with the best results. I ask you to use the same remedy when you are troubled with a cough. This prescription may seem so simple that you feel no confidence in it, but I have tried it for a number of years and can highly recommend it. {2SM 301.1} Of course, moderation is important.

So in conclusion:

“Eat honey, my son, for it is good…” Proverbs 24:15 NIV“It is not good to eat too much honey. Proverbs 25:27 NIV“If you find honey, eat just enough—too much of it, and you will vomit. Proverbs 25: 17 NIV

Use more natural sugars from fresh and dried fruits to satisfy your sweet-tooth and reap the benefits of phytochemicals, fiber, and vitamins. Date sugar has all of the fiber but is also expensive. When using sugar, use whole can sugar that preserves some vitamins and minerals found in the whole sugar cane.

One practical application is that since honey and fructose are sweeter than table sugar (sucrose) so less can be used.

Use more fruits to satisfy your sweet tooth. Remember the old saying that “An apple a day keeps the doctor away.” In one study, 1,381 students at Michigan State University participated in a group study that did just that and they had: fewer illnesses, less pressure and tension headaches, less nervousness and insecurity, less common colds and upper respiratory infections, and were better able to

concentrate. Apples are loaded with 60 different phytochemicals including some that give them their aroma, as well as carotenes. One unpeeled apple daily helps lower cholesterol. Two apples/daily for 3 weeks lowers the blood cholesterol by 10 mg.

Interestingly, brushing and rinsing with toothpaste after meals eliminates 65.3% of bacteria in the mouth. An apple eaten at the end of a meal eliminates 96.7% of the bacteria in the mouth. (School of Health, March 1979, Lavonne Hoover p. 128)

The Bottom Line

A high sugar diet contributes to obesity since most sweet foods are also high in calories that don’t fill us up but out.

Honey is better than sugar and twice as sweet. When substituting sugar with honey, just add ½ the amount of honey and cut back a little on liquids in the recipe.

Whole fruits, packaged with fibers and phytochemicals, are the best way to satisfy a sweet tooth.

The US Department of Agriculture recommends that you limit your added sugars to: 6 teaspoons on 1,600 calories/day diet; 12 teaspoons on 2,200 calories/day diet or 18 teaspoons on 2,800 calories/day diet.

All rights reserved by The College of Health Evangelism, 2010

References

Al-Waili, N.S, Natural honey lowers plasma glucose, C-reactive protein, homocysteine, and blood lipids in healthy, diabetic, and hyperlipidemic subjects: comparison with dextrose and sucrose, J. Med. Food, 2004, Spring;7(1):100-7

American Society for Biochemistry and Molecular Biology (2007, December 10). Sugary Beverages May Increase Alzheimer's Risk. ScienceDaily. Retrieved February 12, 2009, from http://www.sciencedaily.com /releases/2007/12/071208142559.htm

Avena, N.M. et al., Sugar and Fat Bingeing Have Notable Differences in Addictive-like Behavior, J Nutr. 2009 Jan 28.

Avena, NM, et al., Sucrose sham feeding on a bing schedule releases accumbens dopamine repeatedly and eliminates the acetylcholine satiety response, Neuroscience. 2006;139(3):813-20

Avena, NM, et al., Evidence for sugar addiction: behavioral and neurochemicals effects of intermittent, excessive sugar intake, ; Neurosci Biobehav Rev. 2032(1):20-39, 2008

Baldwin, B.E., et al, Foods for Thoughts, Remnant Publishers, 2004.

Boyles, Salynn Alzheimer's: Are They Linked? In Small Study, Sugar-Fed Mice Showed More Evidence of Plaques in Brain. WebMD Health News.

Busserolles, Jerome, et al, Short-term consumption of a high-sucrose diet has a pro-oxidant effect in rats, British Journal of Nutrition, (2002), 87, 337–342.

Boston University (2008, July 30). Study Links Soft Drinks And Fruit Drinks With Risk For Diabetes In African-American Women. ScienceDaily. Retrieved February 13, 2009, from http://www.sciencedaily.com /releases/2008/07/080728192811.htm

Cornell University (2003, June 27). Too Many Sweetened Drinks, From Soda To Lemonade, Put Children At Risk For Obesity, Poor Nutrition, Study At Cornell Finds. ScienceDaily. Retrieved February 13, 2009, from http://www.sciencedaily.com /releases/2003/06/030626235716.htm

Czyzyk, Traci A. et al., Opioid receptors control the metabolic response to a high-energy diet in mice. The FASEB Journal, 2009; DOI: 10.1096/fj.09-143610

Diet and regular soft drinks linked to increase in risk factors for heart disease Published on

Wednesday, August 01, 2007 by Healthy News Service

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Dhingra, R., et al., Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community, Circulation. 2007 Jul 31;116(5):480-8

Edwards, NL., The role of hyperuricemia and gout in kidney and cardiovascular disease, Cleve Clin J Med. 2008 Jul;75 Suppl 5:S13-6

Erlanson-Albertsson C., Sugar triggers our reward-system. Sweets release opiates which stimulates the appetite for sucrose--insulin can depress it, Lakartidningen. 2005 May 23-29;102(21):1620-2, 1625, 1627

Gosnell, B.A., et al., Sucropse-intake predicts rate of acquisition-of-cocaine self-administration, Psychopharmacology (Berl). 2000 Apri; 149(3):286-92.

http://www.rotten.com/library/crime/drugs/sugar/

http://www.bloodsugarpack.com/causes.htm - Causes of Diabetes and Insulin Resistance

Hanson, M. et al., Sucrose and IQ induced mutations in rat colon by independent mechanism,

Mutat Res. 2004 Oct 4;554(1-2):279-86.

Jarvi, A.E., et al, Improved glycemic control and lipid profile and normalized fibrinolytic activity on a low-glycemic index diet in type 2 diabetic patients, Diabetes Care. 1999 Jan;22(1):10-8

Jeppesen, P.B., Stevioside acts directly on pancreatic beta cells to secrete insulin; actions independent of cyclic adenosine-monophosphate and adenosine-triphosphate-sensitive K+- channel activity, Metabolism, 2000, 49(2); 208-214.

Jurdak N, Kanarek RB. Sucrose-induced obesity impairs novel object recognition learning in young rats, Physiol Behav. 2009 Jan 8;96(1):1-5

Jurdaka, Nicole, et al., Sucrose-induced obesity impairs novel object recognition learning in young rats. http://linkinghub.elsevier.com/retrieve/pii/S0031938408002436

Liebman, Bonnie, Nutrition Action, Volume 25, Number 9, Center for Science in the Public Interest, pp.3-7

Lindqvist A, et al., Effects of sucrose, glucose and fructose on peripheral and central appetite signals, Regul Pept. 2008 Oct 9;150(1-3):26-32.

Lugsbe, P. E., Honey: a potent agent for wound healing? J Wound Ostomy Continence Nurs. 2002 Nov;29(6):295-300

Monash University (2008, August 22). Killer Carbs: Scientist Finds Key To Overeating As We Age. ScienceDaily. Retrieved February 13, 2009, from http://www.sciencedaily.com /releases/2008/08/080821110113.htm; Whitney, Ellie and Rolfes, Sharon. 10th edition.

Molteni, R., et al, A high-fat, refined sugar diet reduces hippocampal brain-derived neurotrophic factor, neuronal plasticity, and learning, Neuroscience, 2002; 112(4):803-14.National Research Council, Diet and Health, National Academy Press, 1989, pp. 274-284.

Neil Nedley, M.D., Proof Positive, Quality Books, Inc. 1998, pp. 171-188.Whitney, Cataldo, Rolfes, Understanding Normal and Clinical Nutrition, 5th Edition, Wadsworth, 1998, pp. 121-138.

Paul, IM, Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents, Arch Pediatr Adolesc Med. 2007 Dec;161(12):1140-6

Princeton University (2008, December 11). Sugar Can Be Addictive: Animal Studies Show Sugar Dependence. ScienceDaily. Retrieved February 12, 2009, from http://www.sciencedaily.com /releases/2008/12/081210090819.htm

Rada, P, et al., Daily bingeing on sugar repeatedly releases dopamine in the accumbens shell, Neuroscience. 2005;134(3):737-44

Sharma, N., et al., High-sugar diets increase cardiac dysfunction and mortality in hypertension compared to low-carbohydrate or high-starch diets, J Hypertens. 2008 Jul;26(7):1402-10

Shoham, D.A., et al., Sugary soda consumption, and albuminuria: results from the National health and Nutrition Examination Survey, 1999-2004, PLoS ONE. 2008(3(10:e3431

Tran-Nguyen, Ly T. L., et al. Serotonin depletion attenuates cocaine seeking but enhances sucrose seeking and the effects of cocaine priming on reinstatement of cocaine seeking in rats, Psychopharmacologia   ISSN 0033-3158, 2001, vol. 157, no4, pp. 340-348 

Yaghoobi N, et al, Natural honey and cardiovascular risk factor; effects on blood gluose, cholesterol, triacylglycerole, CRP, and body weight compared with sucrose, ScientificWorldJournal. 2009 Apr 20:8:463-9.

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