Thursday, July 28, 2016

The Little White Crystal

I'll be the first to admit, I have a sweet tooth. I'm notorious in my family as the cookie dough thief, a title earned after my early achievement of sneaking an entire double batch of chocolate chip cookie dough from the fridge when I was 6. That title was well-earned and reaffirmed many times over the years.

That being said, I want to talk for a second about sugar.

Sugar is everywhere.

It's in your cereal, your bread, your pizza sauce, your drinks, your snacks, your desserts... It's all over the place. What's more, majority of that sugar is what are called empty calories. To break that down (excuse the pun), a calorie is a unit of energy, defined as the amount of energy required to bring 1 ml of water from 14 to 15 degrees Celsius. Empty calories are sources of calories which provide no other nutrient benefit, think for example, bread made from refined, non-fortified flour versus bread made from home-ground flour from whole wheat grains. Refined, non-fortified flour us pure carbohydrates with no other nutrients, whereas the wheat germ from the whole grain provides many essential nutrients.

Now, our energy intake is often measured in Calories, not calories. What's the difference? Calories, with a capital "C" are actually kilocalories, kcal or 1000 calories. Our recommended daily allowances are often based on a 2000 Calorie (kcal) diet. This is calculated from a simple formula:

  • 1 gram of protein ~ 4 kcal
  • 1 gram of carbohydrates ~ 4 kcal
  • 1 gram of fat ~ 9 kcal
Now, seeing that energy difference, many of you are probably thinking, "Why are we talking about sugar then? Fat has far more Calories." You are not alone in your thinking. If you want to see the biochemistry behind the push against sugar, then check out The Fat-Sugar Metabolism Debate  (TFSMD).

Interestingly enough, we have a recommended daily amount for sugar: 24-36 grams[1]. That's not a lot; it's roughly 6-9 teaspoons per day. Two sugars in your coffee? you've already hit 1/3 of your daily allowance. 

Two sugars? Really?

Yeah, and it doesn't stop there. We've already discussed how excess sugar leads to obesity, diabetes, cardiovascular disease, and coronary artery disease in TFSMD. What's I'm trying to show you is that sugar, truly, is everywhere. The scary part of all of this is that you don't need to be eating a diet of candy for breakfast, lunch, and dinner to wind up with way more sugar than you need.
Sorry, Buddy
Next time you grab a can of coke, check the amount of sugar in it - 39 grams. Grabbing a pack of Pop-Tarts or a bowl of Frosted Flakes for breakfast? 34 and 25 grams respectively. Fruit juice isn't even safe, weighing in at around 24 grams per 8 oz of juice.[2]

All right, wise guy, what am I supposed to do, not eat anything?

No. You need to eat, but instead of buying pre-packaged, pre-made foods, why not make it yourself? Sure, it takes time and work has chewed you up and spat you out. I understand. I'm a med student and, for a while, my wife worked two jobs on top of that - we were never home and rarely had the time to cook. For the time being, we had to be content with that, but we still tried to make healthy choices when eating out (particularly after going through the GI/nutrition course). 

Don't kill yourself trying to avoid sugar, but do what you can to minimise it. That's why we have nutrition labels on foods. Find the sugars, see how much is in one serving and do the math to figure out how much sugar is in the whole bag (because we never eat just 3 oreos, right?).

Also, if you're really curious, you can look at the ingredients list to see where and what type of sugar is listed. If you didn't know, the ingredients are listed in order of amount, from most to least. So, if sugar is high on the list, you know there's a lot of it. That being said, producers have found alternative ways to get sugar in food without using literal sugar (table sugar), so you'll have to be extra canny, scanning for all of these other names for sugar (Not all of these are exactly the same as table sugar and sometimes have different structures, but they are still all empty calories and sweeteners)[3, 4]:

  • Agave nectar/syrup
  • Barbados sugar
  • Barley malt
  • Barley malt syrup
  • Beet sugar
  • Blackstrap molasses
  • Brown rice syrup
  • Brown sugar
  • Buttered sugar
  • Cane juice crystals
  • Cane juice
  • Cane sugar
  • Caramel
  • Carob syrup
  • Caster/Castor sugar
  • Coconut sugar/Coconut palm sugar
  • Corn sweetener
  • Corn syrup
  • Corn syrup solids
  • Crystalline fructose
  • Date sugar
  • Demerara sugar
  • Dextran/Dextrin
  • Dextrose
  • Diastatic malt
  • Diatase
  • Ethyl maltol
  • Evaporated cane juice
  • Fructose
  • Free-flowing brown sugars
  • Fruit juice concentrates
  • Galactose
  • Glucose
  • Glucose solids
  • Golden sugar
  • Golden syrup
  • Grape sugar
  • High fructose corn syrup
  • Honey
  • Invert/-ed sugar
  • Lactose
  • Malt syrup
  • Maltodextrin
  • Maltose
  • Mannose
  • Maple syrup
  • Molasses syrup
  • Muscovado sugar
  • Organic raw sugar
  • Oat syrup (avena sativa)
  • Panela
  • Panocha/Penuche
  • Powdered/Icing/Confectioner's sugar
  • Refiner's syrup
  • Rice bran syrup
  • Rice syrup
  • Saccharose
  • Sorghum
  • Sorghum syrup
  • Sucrose
  • Sugar
  • Syrup
  • Treacle
  • Tapioca syrup
  • Turbinado sugar
  • Yellow sugar

The Fat-Sugar Metabolism Debate

Back in the 50's when the heart health debates were raging, given clear connection between body fat and heart disease, scientists were divided between whether dietary fat or dietary sugar contributed to body fat. At the time, the dietary fat camp won. Today, however, thanks to modern biochemistry, we know that it's not quite that simple. To highlight this, let me give you a simplified summary of the biochemistry of metabolism when energy is needed (fasted state):

With permission from my biochemistry professor
Now that you've been thoroughly bewildered, I want to focus on two key aspects of metabolism: energy use and energy storage. (No, I won't share any more biochem slides).

Glucose, the most prevalent form of sugar used, is converted to pyruvate in all cells, which, in most cells is converted to Acetyl-CoA, which is sent through the Krebs cycle to generate more energy.

Other sugars are converted to glucose or a subsequent product on the glycolysis pathway

Fats are delivered as fatty acids directly to the muscles, which are converted to Acetyl-CoA and are slotted into the Krebs cycle. In the liver, they're converted to ketone bodies for use in the muscle and brain or packaged into VLDL for distribution as fatty acids.

So, when energy is needed, both forms are used, but I want to direct you to something in the bottom left corner entitled "Carb flame". A funny quirk about the Krebs cycle: with just the right amount of carbohydrate, the Krebs cycle skips a couple steps and becomes a super-efficient fat-burning powerhouse.

So, then, what happens when you have more energy than you need? It goes to storage. All sugars, except Fructose, are initially converted to glycogen for storage. When the glycogen stores are filled up, they are then converted to fat. Fructose, however, is not able to be converted to glycogen in the liver, which is the main processing centre, so it goes straight to fat. Yes, Fructose can be converted to glycogen in the muscle, and certain other tissues, but the volume processed is significantly less.

I want to note, quickly, that Fructose is the sweet sugar. It's found in high-fructose corn syrup and is also part of cane sugar (which includes white/table sugar, brown sugar, and molasses/treacle).

Dietary fat storage is much simpler. It's stored as fat.

Hmm... I seem to be losing my case aren't I. Well, let's consider the factors controlling whether your body is using or storing energy: your hormones.

Insulin and Glucagon are the two key players here. Now, as I promised not to inject any more biochem slides, you'll have to trust me, okay?

Glucagon triggers the body to release storage forms of energy because the body needs energy now. Remember, when Glucose is gone, you need Glucagon. Insulin triggers the body to store energy when there is excess. As such, Insulin is responsible for activating and increasing the number of proteins that convert sugars to glycogen and Fructose, fatty acids, and excess sugars to fat.

Here's the kicker: Glucose drives insulin secretion. What's more interesting, though, is that glucose taken orally (eaten) causes insulin to spike more than insulin taken by injection. Now, yes, free fatty acids also contribute to insulin production, but to a lower degree and I must note that majority of fatty acids in the body are not free-circulating.

So, what's the verdict? Both dietary fat and sugar are metabolised to produce energy when needed. Both dietary fat and sugar are stored when not needed. It would appear, then, that both are beneficial, in the right amounts. Too much dietary fat will contribute to body fat. Too much dietary sugar will also contribute to body fat. Unlike dietary fat, though, excess dietary sugar will contribute to elevated insulin levels.

Oh, if I had the space to begin discussing the effects of chronic high insulin, but, in short form, high insulin levels can lead to high blood pressure, type 2 diabetes mellitus, coronary artery disease, cardiovascular disease, obesity, polycystic ovarian syndrome, and a couple other chronic health conditions.

Again, sugar, like fat, is not bad in moderation, but, in excess, it is a cause of many of the health problems that plague us today in America.

Wednesday, July 27, 2016

Vanity, Vanity. All is Vanity

So, I was taking some time to read the Bible this morning, something I like to do, but sometimes fail to make time to enjoy, and one verse really hit me between the eyes. It stood out, because, to me, it highlighted something that is often taken for granted or even glossed over in today's Church, particularly the Western Church.

The verse, in context, read as follows:
"Now, brothers and sisters, I want to remind you of the gospel I preached to you, which you received and on which you have taken your stand. By this gospel you are saved, if you hold firmly to the word I preached to you. Otherwise, you have believed in vain." 
- 1 Cor. 15:1-2 (Emphasis added)
Paul is quick to make note here that receiving and standing upon the Gospel is not enough. You can listen to the Gospel as much as you want, but it doesn't make you a Christian, he is saying. You can choose to live your life by Christian principles and believe in the historicity of Christ, but that doesn't make you a Christian. You can identify with the church and push for the moral establishment that comes with it, but that doesn't make you a Christian.

All of that, Paul says, is vanity, emptiness, nothingness, a waste of breath. If that is all you believe about Christ, if that is all you consider to be Christianity, then you have believed in mere smoke.

What, then, does true belief that brings about salvation consist of?

I means listening to the Gospel and internalising it, making it a part of your everyday being. It means living your life at the footsteps of Christ, believing in the deity of Christ. It means identifying with the church, standing in solidarity with persecuted brothers and sisters, withstanding persecution yourself and, yet, with grace and forgiveness, loving the world whose morals are so far from Christ as the East is from the West.

A faith that saves is one that, as Paul writes, holds firmly to the Gospel, never wavering or compromising in belief, no matter what storms may come.

Friday, July 22, 2016

The Christian Race

With police violence protests, #blacklivesmatter protests, and counter protests flying everywhere throughout the U.S. and much of the world, I thought I'd share something I read today that might, hopefully, spur on those of us who claim to follow Christ:

For just as the body is one and has many members, and all the members of the body, though many, are one body, so it is with Christ. For in one Spirit we were all baptized into one body—Jews or Greeks, slaves or free—and all were made to drink of one Spirit. For the body does not consist of one member but of many. If the foot should say, "Because I am not a hand, I do not belong to the body," that would not make it any less a part of the body. And if the ear should say, "Because I am not an eye, I do not belong to the body," that would not make it any less a part of the body. If the whole body were an eye, where would be the sense of hearing? If the whole body were an ear, where would be the sense of smell? But as it is, God arranged the members in the body, each one of them, as he chose. If all were a single member, where would the body be? As it is, there are many parts, yet one body. The eye cannot say to the hand, "I have no need of you," nor again the head to the feet, "I have no need of you." On the contrary, the parts of the body that seem to be weaker are indispensable, and on those parts of the body that we think less honorable we bestow the greater honor, and our unpresentable parts are treated with greater modesty, which our more presentable parts do not require. But God has so composed the body, giving greater honor to the part that lacked it, that there may be no division in the body, but that the members may have the same care for one another. If one member suffers, all suffer together; if one member is honored, all rejoice together.
1 Corinthians 12:12‭-‬26 ESV

Tell me please, church, where it tells us to let our brothers and sisters struggle alone?

Paul is pretty clear here. As a white Christian, when Black Christians, Hispanic Christians, Asian Christians, Arabic Christians, Coptic Christians or other Christians suffer, I suffer. Why? We are one body.

Take a look at your body. When your toe jams into the doorway, it's not just your toe that is affected. When your tiny, seemingly purposeless appendix gets infected, your entire abdomen feels the pain.

We are all equal under Christ. There is no division by race, status, money, or language, but that doesn't mean we are all the same. Just as the body is composed of many parts, the church is a conglomeration of thousands of backgrounds, races, languages, social strata, and perspectives. If we are ever to achieve unity within the church, let alone the country, we need to begin by appreciating and supporting our brethren from different backgrounds. We need to apologise where necessary, lend a hand where needed, break bread together when able, and see each other's humanity and worth at all times.